Prevalence of oral frailty and its association with dietary variety, social engagement, and physical frailty: Results from the Oral Frailty 5-Item Checklist

AIM

This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty.

METHODS

We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score ≤3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score ≥3).

RESULTS

A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94).

CONCLUSIONS

Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. Geriatr Gerontol Int 2024; 24: 371-377.

Cyclic Fatigue Properties of Titanium Alloys for Application in Dental Implants

The present study investigated the cyclic fatigue properties of titanium alloys (Ti-6Al-4V and Ti-6Al-7Nb) as implant materials and compared their properties with those of commercially pure titanium. Ti-6Al-4V and Ti-6Al-7Nb cylinders with diameters of 3.0 mm were examined. The surfaces of the cylinders were roughened by sand blasting with alumina particles and acid etching. Static and cyclic tests were performed according to ISO 14801:2016. The yield force in the static test (YS) was measured in 5 specimens of each alloy using a universal testing machine. The yield force in a cyclic test (YC) was measured in 20 specimens of each alloy using the staircase method, which involved applying a cyclic load at a frequency of 10 Hz for 106 cycles. After the cyclic loading tests, cross-sections of the specimens were examined under an optical microscope. The YS values for Ti-6Al-4V and Ti-6Al-7Nb were 1463 N±93 N and 1405 N±79 N, respectively, and the YC values were 870 N±58 N and 853 N±202 N, respectively. Microscopic observation revealed cracks on the tensile side of some of the specimens, including run outs and failures. The results of this study suggest that the YC values for Ti-6Al-4V and Ti-6Al-7Nb were 40% less than those for YS. The yield force of Grade-4 Cp-Ti significantly decreased after cyclic loading. The YC values for Ti-6Al-4V and Ti-6Al-7Nb were approximately 900 N, which was markedly greater than that for commercially pure, Grade-4 titanium (700 N).

Obstructive azoospermia caused by epididymis injury with testicle rupture on the other side

Background

Epididymal injuries without ipsilateral injuries of the testicles are rare. We report a case of a solitary right epididymal injury complicated by left testicular rupture.

Case Presentation

A 21-year-old man experienced scrotal trauma caused by a motorcycle accident. Bilateral swelling and tenderness of the scrotum were observed. Ultrasonography and computed tomography revealed a ruptured left testicle; therefore, surgery was performed. During surgery, the left testicle was excised because it was completely ruptured, and the right testicle and epididymis were evaluated to identify the cause of swelling of the right scrotum. The right testis was not injured; however, the right epididymis was lacerated. Subsequently, the lacerated right epididymis was repaired using sutures. A semen analysis performed at 1, 4, and 7 months after surgery revealed the absence of sperm in the semen.

Conclusion

Epididymal injuries should be considered as differential diagnoses for scrotal trauma.

Effect of Professional Denture Cleaning on Surface Roughness of Silicone or Acrylic Soft Relining Materials

The aim of this study was to investigate the effects of combining mechanical (ultrasonic) and chemical cleaning (using denture cleaners) on the surface roughness of silicone or acrylic soft relining materials. The silicone soft relining material with the lowest Shore A hardness and a acrylic soft relining material routinely used in Japan were selected. Four groups were established based on type of treatment: immersion in water (W); ultrasonic cleaning in tap water (U); ultrasonic cleaning in a hypochlorous acid denture cleanser (HU); or ultrasonic cleaning in an acidic denture cleanser (AU). Following the tests, surface roughness was determined as the arithmetic mean height of the surface (Sa) and maximum height (Sz). Data were analyzed using the Kruskal-Wallis test followed by Bonferroni correction for a multiple comparison. No significant difference was observed in the Sa or Sz of the silicone soft relining material between the 4 groups. Significant differences were observed in the Sa of the acrylic soft relining material between Groups W and HU (p=0.008) and between Groups W and AU (p=0.008), but no significant differences in the Sz among the 4 groups. Combining U with AU or U with HU yielded no increase in the surface roughness of the silicon soft relining material. The surface roughness of the acrylic soft relining material showed an increase, however, with the combination treatments used.

Oral Function for Diagnosing Oral Hypofunction in Healthy Young Adults: A Comparison with the Literature

This study investigated decline in oral function in healthy young adults and compared it with that observed in an earlier studies employing older adults. The participants comprised 130 young healthy adults (mean age 24.1±2.9 yr), all with complete dentition. All participants underwent the oral hypofunction test established by the Japanese Society of Gerodontology, which evaluates oral hygiene, oral dryness, occlusal force, tongue-lip motor function (oral diadochokinetic rate; ODK), tongue pressure, and masticatory and swallowing function. The average value for and rate of hypofunction of each parameter were calculated. In healthy young adults, the scores were 28.9±17.1% for oral hygiene; 28.8±2.2 for oral dryness; 959.9±499.8 N for occlusal force; 7.0±0.8 times/sec for ODK /pa/, 7.6±0.8 times/sec for /ta/, and 6.9±0.9 times/sec for /ka/; 41.8±8.4 kPa for tongue pressure; 249.8±94.1 mg/dl for masticatory function; and 0.2±0.7 for swallowing function. No sign or symptom of change in oral function was observed at a high rate in young adults. Occlusal force, tongue-lip motor function, and tongue pressure showed a large difference in the rate of hypofunction between younger and older adults, however.

Influence of Chewing Gummy Jelly Containing Aroma Compound on Psychological Stress and Autonomic Nervous System Activity: A Randomized Crossover Trial

The aim of this randomized crossover trial was to clarify the effects of chewing gummy jelly containing a compound of decanoic acid, oligonol, methyl cellulose, and citral (DOMAC) on mental stress and autonomic nervous activity in facemask wearers. A placebo gummy jelly was used in conjunction with DOMAC. Eight healthy adults with no tooth loss (mean age: 35±5 yr) were included. The participants were required to chew one DOMAC or placebo gummy jelly for 5 min after wearing a facemask for 20 min in the laboratory, then the other gummy jelly after a washout period. Rate of change in salivary immunoglobulin A (IgA) as a marker of stress was compared between before and after chewing. Additionally, sympathetic and parasympathetic activity was compared at both time points. A significant difference was observed in the percentage change in salivary IgA from that at before wearing a facemask: 127±34% (mean±standard deviation) while wearing a facemask; 46±20% while chewing DOMAC gummies; and 47±26% while chewing placebo gummies (p<0.05). Parasympathetic nervous system activity was 971.2±1040.7 ms2 at 20 min after facemask wearing; 295.0±253.0 ms2 after DOMAC gummy chewing; and 1956.1±2798.0 ms2 after chewing a placebo gummy jelly; with significant differences only being found between 20 min after facemask wearing and after DOMAC gummy chewing (p<0.05). Sympathetic nervous system activity was 1.80±1.83 at 20 min after facemask wearing; 4.06±3.33 after DOMAC gummy chewing; and 4.95±7.02 after chewing a placebo gummy jelly; with significant differences only being found between 20 min after facemask wearing and after DOMAC gummy chewing. These results suggest that chewing gummy jellies containing DOMAC relieves stress caused by facemask wearing and activates sympathetic nervous system activity.

Changes in Target Coverage and Dose to the Normal Brain during Fractionated Stereotactic Radiotherapy for Metastatic Brain Tumors

PURPOSE/OBJECTIVE(S)

Fractionated stereotactic radiotherapy (SRT) has been applied to large brain metastases to reduce the risk of radiation necrosis. For fractionated SRT, potential of interfractional tumor changes during the treatment period, such as tumor size, shape, and geometry, must be considered to improve the tumor local control. Our center performs adaptive re-planning for large brain metastases based on repeat MRI verification with a contrast agent in the middle of the treatment period. Purpose of this study is to evaluate the dosimetric impact of the changes in tumor size, shape, and geometry on the doses to the targets and normal brain in patients with brain metastases undergoing fractionated SRT.

MATERIALS/METHODS

Fifteen solitary large intracranial metastatic lesions treated with fractionated SRT were investigated. Standardized planning MRI (MRI-1) and repeat verification MRI (MRI-2) were performed during the middle of the irradiation period. The GTV on the MRI-1 and MRI-2 scans was contoured by the same oncologist. The PTV was created by adding an isotropic margin of 1 mm from the GTV in all directions. Volumetric modulated arc therapy (VMAT) with beam energies of 6 MV (flattening filter-free mode) was used and plans were normalized such that PTV D95% or D98% was equal to the prescribed dose. Beam configuration and intensity on the initial VMAT plan were used to evaluate the dose to the tumor and the normal brain on MRI-2. We evaluated the impact of D98% on the GTV using the plans on the MRI-1 and MRI-2 scans. For the normal brain, the V90%, V80%, and V50% were investigated.

RESULTS

The median GTV changed from 9.8 cc (range of 3.2-33.0 cc) to 9.7 cc (range of 2.8-36.5 cc) (p = 0.482). Three and four tumors exhibited volume shrinkage and enlargement changes of >10%. Five tumors exhibited volume shrinkage and enlargement changes of <10%. Three tumors showed no volume changes. Of the 15 large brain metastases, 12 tumors required treatment plan modification. The dosimetric parameters of the GTV, PTV, and normal brain did not significantly differ between the MRI-1 and MRI-2 scans. Regarding the tumor dose, the D98% to the GTV increased in patients with tumor shrinkage because of dose inhomogeneity and decreased in patients with tumor enlargement. The V90%, V80%, and V50% increase with decreasing tumor volumes and were linearly related to the tumor volume difference, with a coefficient of determination of 0.97, 0.98, and 0.97, respectively.

CONCLUSION

Our study demonstrated the usefulness of repeat verification MRI for adaptive radiotherapy in the middle of the treatment period due to changes in tumor size, shape, and geometry in patients with brain metastases. Repeated MRI should be considered to evaluate the dose to the target and normal brain, which improves tumor local control and reduces brain necrosis, to reduce the magnitude of underdosing to the target or overdosing to the normal brain during the treatment period.

Oral frailty five-item checklist to predict adverse health outcomes in community-dwelling older adults: A Kashiwa cohort study

AIM

To enable easy assessment of oral frailty; that is, an overlapping slight decline in multifaceted oral function, in any setting, we developed the oral frailty five-item checklist (OF-5), and examined its predictive validity for increased risks of physical frailty, physical disability and mortality among community-dwelling older adults.

METHODS

This population-based cohort study randomly selected 2044 residents in Kashiwa, Japan, with no long-term care needs. Baseline data were collected in 2012, and follow-up data were collected in 2013, 2014, 2016, 2018 and 2021. The OF-5 includes five measures: fewer teeth, difficulty in chewing, difficulty in swallowing, dry mouth and low articulatory oral motor skills. Physical frailty was defined according to the Cardiovascular Health Study criteria. Physical disability and mortality determined from the long-term care insurance receipt database were followed for 9 years.

RESULTS

Of 2031 eligible participants (mean age 73.1 ± 5.6 years; 51.1% women), 39.3% individuals with ≥2 OF-5 points had significantly increased prevalence and new-onset rate of physical frailty. After adjusting for potential confounders, oral frailty, defined as ≥2 OF-5 points, was associated with increased risks of physical disability (adjusted hazard ratio 1.40; 95% confidence interval 1.14-1.72) and mortality (adjusted hazard ratio 1.44; 95% confidence interval 1.11-1.87). The highest adjusted hazard ratios were observed in older adults with coexisting physical and oral frailty.

CONCLUSIONS

The OF-5 showed strong predictive validity for physical frailty, physical disability and mortality in Japanese older adults. This assessment tool can be implemented in various settings and foster comprehensive prevention through interprofessional collaboration. Geriatr Gerontol Int 2023; 23: 651-659.

Maxillary Obturator Prosthesis Made with Polyetherketoneketone Using Optical Impression and CAD/CAM System

This report describes the case of a 68-year-old man who visited our department complaining of poor denture retention and difficulty masticating due to damage to the retainer of a maxillary obturator. The patient had never been satisfied with the fit of this prosthesis, which had been placed two years earlier. The obturator and the mucosal surface of the denture base were incompatible, which had caused the retainer to detach. The maxillary defect was categorized as H3S0D0T0 according to the HS classification. The diagnosis was a masticatory disorder due to a damaged retainer and an incompatible denture base. Optical impressions and occlusal records were taken and a maxillary obturator fabricated using a CAD/CAM system. Dental CAD software was used to design and complete the tooth arrangement. The CAM system was used to mill a polyetherketoneketone disc based on the obtained data and composite resin used to face the teeth and gingiva. The maxillary obturator was placed after only three visits, spanning from impression taking to denture completion. The use of digital data allowed the time to denture completion to be shortened in addition to the number of hospital visits to be reduced. Compared to conventional impression taking, optical impressions also prevent discomfort, decreasing stress for the patient.

Effect of elastic oral appliance chewing on frontal lobe activity

OBJECTIVES

Chewing increases frontal lobe activity, resulting in improved memory, learning ability, and response reaction time. This study aimed to assess the effects of elastic oral appliance chewing on the activities and functions of the frontal lobe.

METHODS

The study participants were 15 healthy men with full dentulous (mean age, 27.4 ± 4.1 years). A prospective crossover design was used to assess frontal lobe activities and functions. Changes in frontal lobe activities were measured with near-infrared spectroscopy (NIRS). At baseline, the participants were assessed in the resting state. Changes in channels #7, representing right frontal lobe activities by NIRS, and #10, representing left frontal lobe activities, during the first and second chewing periods in a total of two periods were evaluated. Frontal lobe functions were measured using the Trail Making Test Part A (TMT-A) in the resting state and after elastic oral appliance or gum chewing. These values were compared with each period.

RESULTS

Elastic oral appliance chewing caused significant differences between the baseline and first chewing periods for channel #7 (p = .032) and significant differences between the baseline and second chewing periods for channels #7 and #10 (p < .001 and p < .001, respectively) using NIRS. Moreover, significant differences were found in the TMT-A results between the resting state and elastic oral appliance chewing (p = .04).

CONCLUSIONS

Elastic oral appliance chewing improves frontal lobe activities to a level similar to that obtained with gum chewing.

Consideration of mouth opening when using positioning stents during radiotherapy for tongue cancer: a retrospective study

Background

The aim was to clarify the range of mouth opening required to minimize the development of oral mucositis on the palate while using a positioning stent during radiotherapy in patients with tongue cancer. A positioning stent is used to reduce the severity of oral mucositis; however, requirements for fabricating the device have not been standardized. In particular, the range of mouth opening required while using a stent to prevent radiation-induced oral mucositis has not been determined.

Materials and methods

We retrospectively analyzed medical records and computed tomography (CT) images of nine patients who had undergone radiotherapy for tongue cancer. Irradiation dose for the palate and range of mouth opening while using the positioning stent was calculated from CT images and the radiotherapy treatment planning program.

Results

The irradiation dose presented as medians and interquartile range (IQR) for the palate was 1.6 (IQR: 1.1-2.2) Gy with the use of the positioning stent and 37.2 (IQR: 17.5-44.1) Gy without the use of the positioning stent. The range of mouth opening was 19-37 [mean ± standard deviation (SD): 26 ± 5.6] mm, and it correlated with the attenuation amount of irradiation dose to the palate (r = 0.673, p = 0.0467). Regression equation was y = 0.21x + 19.

Conclusions

Our study may be useful for deriving the relationship between the attenuation amount of irradiation of the palate with the positioning stent and the amount of mouth opening required for this attenuation.

Derivation and validation of a machine learning-based risk prediction model for in-hospital mortality in patients with acute heart failure

Background

Although risk stratification is important in patients with acute heart failure (AHF) to predict patient prognosis, pre-existing risk models have not often been used due to its complexity. Recently, machine learning methods have been presented as an alternative approach to analyzing the predictive probability of large clinical datasets.

Purpose

The aim of this study is to develop a user-friendly risk score developed by one of machine learning methods and compare the performance of the new risk score to the existing conventional risk models.

Methods

A machine-learning-based risk model was developed using least absolute shrinkage and selection operator (LASSO) regression by identifying predictors of in-hospital mortality in the derivation cohort (REALITY-AHF) and externally validating and comparing its performance with two pre-existing risk models: the Get With The Guidelines risk score incorporating brain natriuretic peptide and hypochloremia (GWTG-BNP-Cl-RS) and the acute decompensated heart failure national registry (ADHERE) risk model.

Results

In-hospital deaths in the derivation and validation (NARA-HF) cohorts were 76 (5.1%) and 61 (4.9%), respectively. The risk score comprised four variables (systolic blood pressure, blood urea nitrogen, serum chloride, and C-reactive protein) and was developed according to the results of the LASSO regression weighting the coefficient for selected variables using a logistic regression model (4V-RS). Even though 4V-RS comprised fewer variables, In the validation cohort, it showed a higher area under the receiver operating characteristic curve (AUC) than the ADHERE risk model (AUC, 0.783 vs. 0.740; P=0.059) and a significant improvement in net reclassification (0.359; 95% CI, 0.10–0.67; p=0.006). 4V-RS performed similarly to GWTG-BNP-Cl-RS in terms of discrimination (AUC, 0.783 vs. 0.759; p=0.426) and net reclassification (0.176; 95% CI, −0.08–0.43; p=0.178).

Conclusions

The 4V-RS model comprising only four readily available data points at the time of admission performed similarly to the more complex pre-existing risk model in patients with AHF.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Cardiovascular Research Fund

A solitary giant neurofibroma of the left thigh: a case report

A neurofibroma not associated with neurofibromatosis type 1 is termed solitary neurofibroma. A solitary giant neurofibroma of the thigh is an extremely rare tumor. A 44-year-old woman presented to us with a well-defined swelling on her left thigh for 10 years. On the basis of magnetic resonance image finding, we diagnosed the tumor as a neurofibroma. We excised the tumor and the pathological findings established the diagnosis of neurofibroma. There was no recurrence 8-months after surgery.

Effect on Physical Functions of Older Adults When Refraining from Going out due to COVID-19 Restrictions

The study investigated the effect of refraining from going out during the coronavirus disease 2019 pandemic on physical function in community-dwelling older adults. The study included 49 patients who underwent home-visit rehabilitation. Four parameters of physical function—grip strength, five-times sit-to-stand test, single-leg stance test, and standing test for imbalance and disequilibrium (SIDE)—were assessed. They were evaluated before (March 2020) and after (May 2020) the state emergency was imposed, and the results were compared. The grip strength decreased significantly. A significant difference was also observed in the proportion of different SIDE levels in the study group before and after the implementation of the state emergency. The number of SIDE 2a or lower patients increased during the state emergency (p < 0.001). Comprehensive community support and rehabilitation are necessary to maintain physical function in older individuals. In particular, we believe that there is a need to utilize remote rehabilitation using digital devices (such as internet-based guidance) so that older adults can continue to exercise at home.

Oral function and nutritional status in non-acute hospitalised elders

Introduction

Malnutrition and risk of malnutrition continues to be a common finding in elders, yet its association with oral function in hospitalised patients remains unclear.

Material and methods

Patients aged 70 years or over who had been hospitalised for non‐acute rehabilitation were recruited. Nutritional risk was screened using the Mini‐Nutritional Assessment Short Form (MNA‐SF) and Nutritional Risk Screening (NRS) scores. Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. All participants underwent the oral hypofunction test battery, evaluating oral hygiene, oral dryness, occlusal force, tongue‐lip motor function, tongue pressure, masticatory and swallowing function. Statistical analyses comprised Mann‐Whitney or Kruskal‐Wallis tests. Bivariate associations between categorical variables were tested using the Pearson chi‐square test; for continuous variables, the Spearman correlation was calculated. A P‐value < .05 was considered statistically significant.

Results

Sixty patients aged a mean 82.5 ± 7.0 years participated. Some 88.3% were diagnosed with oral hypofunction, and this was more common in older patients (P = .020). Analysing the 7 oral hypofunction tests as an interval variable (NiOF) revealed additional correlations with number of teeth (ρ = 0.477) as well as the nutritional risk, evaluated by the MNA‐SF (ρ = −0.284) and NRS (ρ = 0.317) scores. NiOF scores were higher among denture wearers (P = .003). GLIM did not confirm the correlation with NiOF. Biomarkers such as serum albumin and CRP were not associated with the NiOF score.

Conclusion

In this sample, the association between oral function and nutritional state is more obvious in nutritional risk scores than in the malnutrition diagnosis by GLIM.

Oral function is associated with the body and muscle mass indices of middle-aged dental patients

Objectives

Undernutrition is associated with frailty, one of the common reasons for seeking long‐term care. In older adults, nutritional status is known to be associated with oral function; however, it is not yet known if there is a similar association in middle‐aged adults. The present study determined the association between nutritional status and oral function in middle‐aged adults.

Material and methods

This cross‐sectional study was conducted in 117 outpatients aged 40–64 years who underwent dental check‐up at a private dental clinic. Factors associated with oral function, including oral moisture, number of teeth present, oral diadochokinesis, tongue pressure, lip‐seal strength, and masticatory performance, were evaluated. Body mass index (BMI), fat‐free mass index (FFMI), and skeletal muscle mass index (SMI) were analyzed as nutritional statuses. Pearson's correlation analysis was conducted to determine the correlation between nutritional statuses and other variables. Multiple linear regression analysis was performed, with adjustment for age and sex, using BMI, FFMI, or SMI as response variables and oral moisture, maximum tongue pressure, lip‐seal strength, oral diadochokinetic rate, and masticatory performance as explanatory variables.

Results

All nutritional statuses showed significant correlation with maximum tongue pressure and lip‐seal strength. Multiple linear regression analysis revealed that BMI was associated with maximum tongue pressure and lip‐seal strength, whereas FFMI and SMI showed significant association with sex, maximum tongue pressure, and lip‐seal strength.

Conclusions

In middle‐aged outpatients at a regional dental clinic, lip‐seal strength and tongue pressure were positively associated with BMI, FFMI, and SMI.

Habitual exercise provides better prognosis for cardiac arrest with coronary artery disease

Background

Although regular physical activity has beneficial cardiovascular effects, exercise can trigger sudden cardiac arrest (SCA). Coronary artery disease (CAD) was identified as the most common cause of an exercise-related out-of-hospital cardiac arrest (OHCA). Regular exercise has been reported to reduce the risk of plaque rupture in animal studies and basic research. Therefore, we compared the coronary artery findings in CAD-OHCA patients with and without habitual exercise.

There have been few reports on whether regular exercise changes the prognosis in OHCA due to CAD (CAD-OHCA). We investigated the association between the better clinical outcome and the regular exercise in patients with CAD-OHCA.

Methods

This is a single-center retrospective analysis from 2006 to 2019. The consecutive 397 patients with OHCA due to myocardial ischemia underwent coronary angiography (CAG). After excluding 73 patients with vasospastic angina, the remaining 324 patients with CAD were enrolled in this study. We divided these patients into two groups according to whether they were habitually exercising (Exercise group: N=37) or not/unknown (Non-Exercise group: N=287).

Clinical outcome was a 30-day survival with minimal neurologic impairment represented by a Glasgow-Pittsburgh Cerebral Performance Categories Scale value 1 or 2.

Results

The patients in the Exercise Group were significantly younger (exercise vs. non-exercise, 57±12 vs. 64±12 years; P&lt;0.01) than those in the non-exercise group. The Exercise group had a lower incidence of diabetes mellitus (22% vs. 42%; P=0.02) and a higher incidence of dyslipidemia (81% vs. 62%; P=0.02) than the non-exercise group. The time from collapse to cardiopulmonary resuscitation (1.4±4.0 vs. 3.0±4.8min) and from collapse to return of spontaneous circulation (11.9±10.0 vs. 28.0±25.3min) were shorter in Exercise group (all p&lt;0.05). The ST-segment elevation was recorded on electrocardiography in fewer of the Exercise group (22% vs. 63%; P&lt;0.01). The finding of culprit lesion in the coronary arteries on arrival resulted significant differences between the 2groups (good collateral and/or TIMI3 flow: 62% vs. 25%, the plaque rupture and/or thrombus: 22% vs. 73%) (all p&lt;0.01) (Figure 1). Kaplan-Meier curve showed Exercise group has better neurological outcome at 30days compared than Non-Exercise (95% vs 51%; P&lt;0.001, log-rank test) (Figure 2). Multivariable Cox proportional hazards models revealed that a habitual exercise was one of the predictors of a good neurological outcome (HR 0.21, 95% CI 0.05–0.92; P=0.039).

Conclusions

The patients with habitual exercise had less plaque rupture, less coronary thrombosis than non-exercise. The patients with regular exercise had better clinical outcomes than non-exercise after CAD-OHCA.

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): Tokyo Metropolitan Goverment Figure 1. Findings of the culprit lesion in coronar arteriesFigure 2. Kaplan-Meier analysis

Effect of Lip-seal Resistance Training on Lip-seal Strength in Young Adults

Lip-seal strength is important for articulating bilabials, capturing food during eating, maintaining fluid within the oral cavity before swallowing, and achieving swallowing pressure. The objective of this study was to investigate the effect of lip-seal resistance training on lip-seal strength in young adults. The participants comprised 15 young healthy adults aged 26-34 years, all with complete dentition. Each was required to perform lip-seal resistance training 5 weekdays a week for 4 weeks with a commercially available instrument for that purpose. The instrument was placed on the midline, left corner, and right corner of the mouth, and pulled forward, leftward, and rightward, respectively. The participants were required to pull the training instrument forcefully while resisting by closing the lips together as strongly as possible until the instrument exited the lips. Lip-seal strength was measured at before and after training using a measurement device. Change in lip-seal strength between before and after training was analyzed using the Wilcoxon signed rank test. The mean lip-seal strength was 8.9±1.5 N before training and 10.4±1.8 N after. A significant difference was observed in lip-seal strength between before and after training (p=0.003), and the mean increase during the training period was 18.1±17.6%. The results showed that lip-seal resistance training for 4 weeks increased lip-seal strength in young adults. These findings suggest that training that involves pulling not only in a forward direction, but also in bilateral directions strongly stimulates the orbicularis oris muscle, resulting in an increase in lip-seal strength.

CMR feature tracking cloud assess right ventricular functional reserve with pulmonary arterial hypertension

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI, Grant-in-Aid for Early-Career Scientists.

Background

  Pulmonary arterial hypertension (PAH) remains a fatal disorder characterized by elevated pulmonary arterial pressure. Survival of the patients with PAH is determined from right ventricular (RV) function. CMR has become an attractive modality for following up and providing prognosis in such patients, and CMR feature tracking has been used as a newer useful parameter to assess RV function. However, it has not yet been determined whether CMR feature tracking can assess RV functional reserve in patients with PAH.

Purpose

We investigated whether CMR feature tracking can estimate RV functional reserve using a rat model with PAH.

Methods

 Rats were received injections with monocrotaline (MCT-rats, n = 19) or solvent (Ctr-rats, n = 5). Four weeks after the injections, we performed CMR on 7-T MRI scanner and imaged retrospective ECG-gated cine MR (16 phases/beat). RV ejection fraction (RVEF) and RV strain were analyzed before and after addition of 0.5∼3 nmol endothelin-1 (ET-1). After the measurements, we dissected trabeculae (length = 1.45 ± 0.07 mm, width = 334 ± 27 µm, thickness = 114 ± 6 µm) from the RVs of rat hearts. Trabeculae were electrically stimulated with 2-s intervals at extracellular Ca2+ of 0.7 and 2.0 mmol/L (24°C). Force and maximum dF/dt (dF/dtmax) were then measured using a silicon strain gauge in the absence and presence of 0.1 µM ET-1.

Results

 MCT-rats showed higher systolic RV pressure (RVP), lower RVEF, and lower RV global longitudinal strain (RVGLS) in CMR imaging and showed lower developed force and lower dF/dtmax in their trabeculae. Correlation between RVGLS and dF/dtmax was higher (r = 0.53, p &lt; 0.05) than that between RVEF and dF/dtmax (r = 0.24). In 5 MCT-rats with preserved RVEF (&gt;50%), RVGLS had already been reduced, suggesting that RVGLS is reduced earlier than RVEF. ET-1 increased developed force and dF/dtmax in trabeculae from MCT-rats (12.2 ± 5.7 to 17.4 ± 3.1 mN/mm2 and 0.08 ± 0.03 to 0.14 ± 0.06 mN/mm2/sec, respectively, n = 6), and ET-1 also increased RVP in MCT-rats and Ctr-rats (49.0 ± 19.3 to 59.7 ± 16.8 mmHg in MCT-rats, n = 6, 17.3 ± 7.5 to 20.4 ± 7.8 mmHg in Ctr-rats, n = 2). According to RV global circumferential strain (RVGCS) and RVEF, we could divide MCT-rats into three groups as follows: MCT-rats with reduced-RVGCS (&gt; -20%)/preserved-RVEF (&gt; 50%), MCT-rats with increased-RVGCS (&lt; -30%)/preserved-RVEF and MCT-rats with reduced-RVGCS/reduced-RVEF. ET-1 reduced RVGCS in MCT-rats with reduced-RVGCS/preserved-RVEF, while ET-1 did not change RVGCS in MCT-rats with increased-RVGCS/preserved-RVEF. MCT-rats with reduced-RVGCS/reduced-RVEF died after injection of ET-1.  In Ctr-rats, ET-1 did not change RVGCS and RVEF.  These results suggest that RVGCS can be useful to assess RV functional reserve.

Conclusion

 CMR feature tracking can estimate RV functional reserve earlier and more accurately than RVEF in rats with PAH.  RV strain may become an important parameter to assess RV functional reserve in patients with PAH.

Prognostic impact of six versus eight cycles of standard regimen in patients with diffuse large B-cell lymphoma: propensity score-matching analysis

Background

R-CHOP-21 has been the standard treatment for diffuse large B-cell lymphoma (DLBCL), but there is a paucity of evidence focusing on the number of cycles of regimens.

Patients and methods

We conducted a retrospective study to compare the effectiveness of six cycles of standard regimens versus eight cycles for overall survival (OS) in DLBCL patients using propensity score matching, in consideration of relative dose intensity (RDI).

Results

A total of 685 patients with newly diagnosed DLBCL were identified in three institutions from 2007 to 2017. Patients treated using six cycles of standard regimens were matched by propensity scores with those treated using eight cycles. A 1 : 1 propensity score matching yielded 138 patient pairs. Eight cycles did not significantly improve OS in the conventional Cox proportional hazards model (hazard ratio 0.849, 95% confidence interval 0.453-1.588, P = 0.608). Restricted cubic spline Cox models for OS confirmed that the effect of the number of cycles was not modified by total average RDI, the International Prognostic Index, and age. Occurrence of adverse events did not differ between six and eight cycles.

Conclusion

Even considering the impact of RDI, six cycles of the initial standard regimen for DLBCL is not inferior to eight cycles.

•

The optimal number of cycles of standard regimens including R-CHOP-21 for newly diagnosed DLBCL has not been determined.

•

This study was conducted to verify whether six cycles or eight cycles of standard regimen improved the prognosis of DLBCL.

•

Propensity score matching and a Cox hazards model with restricted cubic spline were used in this study.

•

No survival benefit of eight cycles compared with six cycles was seen, even taking into account RDI.

•

Prognosis was no better with eight cycles of (R-)CHOP-21 or THP-COP-21 than with six cycles, after age and IPI modifications.

Distribution of lip-seal strength and its relation to oral motor functions

Objectives

Lip‐seal strength, which represents the muscle strength of the lips, appears to chiefly contribute to mastication and pronunciation. However, the functional characteristics of lip‐seal strength in adults are still undefined. The present study aimed to understand not only the distribution of lip‐seal strength in adult men and women but also the effect of age on this strength and identify oral motor functions correlated with lip‐seal strength.

Materials and methods

The subjects included 339 participants (men: 170, age 39.2 ± 18.2 years; women: 169, age 43.1 ± 19.7 years). Oral motor function was evaluated for lip‐seal strength, oral diadochokinesis (ODK), tongue pressure, occlusal force, and masticatory performance. Statistical analyses included the Shapiro–Wilk, Mann–Whitney U, and Jonckheere–Terpstra tests, in addition to the Spearman's correlation analysis and curvilinear regression analysis.

Results

Lip‐seal strength did not have a normal distribution (p < 0.001). The mean ± standard deviation and median (first quartile, third quartile) of lip‐seal strength were 11.2 ± 3.4 and 10.9 (8.7, 13.2)N for the whole sample, 12.3 ± 3.4 and 11.9 (9.4, 14.4)N for men, and 10.2 ± 3.0 and 9.9 (8.0, 12.0)N for women. A significant difference was observed in lip‐seal strength between men and women (p < 0.001). Oral motor functions showed a marked correlation with lip‐seal strength, including tongue pressure, occlusal force, and masticatory performance and ODK (/pa/ and /ta/), tongue pressure, and masticatory ability in men and women, respectively. In women, lip‐seal strength declined with increase in age.

Conclusions

Lip‐seal strength was non‐normally distributed in both men and women, and lip‐seal strength was affected by age only in women. Lip‐seal strength and multiple oral motor functions were significantly correlated. Because the indicators of perioral muscle strength and performance were correlated with lip‐seal strength, lip‐seal strength may also partially reflect the condition of the perioral muscles.

An Interprofessional Approach to Oral Hygiene for Elderly Inpatients and the Perception of Caregivers Towards Oral Health Care

OBJECTIVE

The objective of this study was to investigate the effect of an interprofessional oral hygiene support program for elderly inpatients and the perception of caregivers of the elderly towards oral health care.

MATERIALS AND METHODS

Participants comprised 37 elderly inpatients requiring nursing care (17 males, 20 females; mean age, 83.3 ± 4.9 years) and 29 registered nurses who participated in the interprofessional oral health care support program as a caregiver (4 males, 25 females; mean age, 45.2 ± 10.3 years). In this program, inpatients received daily oral cleaning by registered nurses based on each patient's oral health care plan. The number of microbes on the tongue surface of the inpatients was measured once a week for 12 weeks. Additionally, as an investigation of the perception of the caregivers towards oral health care, a questionnaire about the required frequency and duration for oral cleaning was conducted with registered nurses before and after the program to investigate the perception of the caregivers towards oral health care.

RESULTS

Significant differences were observed in the number of microbes on the tongue surface between baseline and at every measurement after the beginning of this program, except for the first week. The mean required frequency and duration for oral cleaning by registered nurses at baseline were 1.5 ± 0.8 times and 3.8 ± 2.2 minutes, whereas those after the program were 2.7 ± 0.7 times and 5.8 ± 2.9 minutes, respectively.

CONCLUSION

Implementation of the program decreased the number of microbes on the tongue surface of the elderly inpatients and improved the perception of their caregivers towards oral health care.

Relationship between two pressure-sensitive films for testing reduced occlusal force in diagnostic criteria for oral hypofunction

OBJECTIVE

To measure the occlusal force in the same group of patients with the Dental Prescale 50H type R and the Dental Prescale II, examine the association between them, and determine the reference value for Dental Prescale II that corresponds to the 50H type R 200 N reference value used to make a diagnosis of oral hypofunction.

BACKGROUND

Reduced occlusal force, a measure of frailty in older persons, was previously determined with Prescale 50H type R pressure-sensitive film, but it has been replaced by the Prescale II.

MATERIALS AND METHODS

The study participants were 441 men and women aged ≥ 65 (mean, 71.8 ± 5.3) years. The occlusal force was measured with the two different types of pressure-sensitive film, and their association was examined. Receiver operating characteristic curves for the Prescale II measured values were created with the 200 N reference value used for the 50H type R film as the cut-off value.

RESULTS

The analysis set included 391 participants for whom measurements were obtained using both the 50H type R and the Prescale II. Linear regression analysis produced regression equations, and a ROC curve analysis provided reference values of 500 N for the Prescale II (without pressure filter) and 350 N for the Prescale II (with pressure filter).

CONCLUSION

In occlusal force tests for making a diagnosis of oral hypofunction, reference values for the Prescale II (without pressure filter) and for the Prescale II (with pressure filter) were determined. The findings suggested that the Prescale II can be used as a diagnostic examination for oral hypofunction.

Effective training duration and frequency for lip-seal training in older people using a self-training instrument

OBJECTIVE

To determine the effects of the training duration and frequency on lip-seal strength (LSS) in older people.

BACKGROUND

Lip-seal is important for speaking, eating and swallowing. LSS decreases after training ends; therefore, continuous training is essential.

MATERIALS AND METHODS

Participants underwent the resistance training of LSS. Regarding training duration, eight women aged ≥65 years participated in a crossover study with trainings A (direction: 1, duration: 50 seconds) and B (directions: 3, duration: 3 minutes), daily for 4 weeks. Regarding training frequency, 40 women aged ≥65 years were divided into four groups based on frequency (everyday, every-other-day, once-a-week and control groups), and all groups excluding the control group performed training B for 4 weeks. LSS was measured at weeks 0, 2 and 4 using a digital strain gauge. Friedman's test was used, followed by Steel-Dwass test (α = 0.05).

RESULTS

Regarding the effects of the training duration, significant differences in LSS were noted between weeks 0 and 4 for training B, but no difference was noted for training A. Regarding training frequency, significant differences were observed between weeks 0 and 2 or 4 in the everyday and once-a-week groups. Significant differences were observed in the every-other-day group between weeks 0 and 4 and no difference in the control group. For all groups, median LSS was higher in week 2 or 4 than that in week 0.

CONCLUSION

Lip-seal training for 3 minutes per session everyday, every-other-day or once-a-week for 4 weeks increased LSS of older people.

Right ventricular longitudinal strain with CMR can more accurately estimate right ventricular functional reserve in rats with pulmonary arterial hypertension

Background

Right ventricular (RV) function is an important prognostic factor in patients with pulmonary arterial hypertension (PAH). Recently, CMR has become an attractive modality for follow up and providing prognosis in the patients, and strain has been used as a newer parameter to assess contractile properties of ventricle. It has not yet been established, however, whether RV strain with CMR can estimate RV functional reserve in the patients with PAH.

Purpose

We focused on CMR imaging of RV, investigating whether RV longitudinal strain can estimate RV functional reserve using a rat model with PAH.

Method

Rats were given a subcutaneous injection of 60 mg/kg monocrotaline (MCT-rats) or solvent (Ctr-rats). Four weeks after the injection, 25% of MCT-rats died due to RV failure. In the survivors of MCT- (n=19) and Ctr-rats (n=5), retrospective ECG-gated cine MR (16 phases/beat) was imaged with a 7T scanner. Subsequently, we measured RV pressure (RVP) via right internal jugular vein and dissected trabeculae (length = 1.45±0.07 mm, width = 334±27 μm, thickness = 114±6 μm) from RVs. We calculated weight ratio of RV free wall to left ventricle (LV) by RV/(LV+septum). Trabeculae were electrically stimulated with 2-s stimulus intervals, and force was measured using a silicon strain gauge (0.7 mM extracellular Ca2+, 24°C). To determine contractile properties of RV muscle, dF/dt was calculated. Using CMR imaging, we measured RV ejection fraction (RVEF) and RV longitudinal strain (RVLS). To modulate RVP, we intravenously injected 5 nmol endothelin-1 (ET-1) and again measured RVEF and RVLS.

Results

MCT-rats showed higher systolic RVP (62.5±16.6 vs. 25.9±1.86 mmHg, p&lt;0.01) and higher weight ratio of RV (0.60±0.03 vs. 0.28±0.02, p&lt;0.05). In CMR imaging, MCT-rats showed lower RVEF (36.1±11.2 vs. 64.8±8.4%, p&lt;0.001) and lower RVLS (−18±9 vs. −30±1%, p&lt;0.05). In trabeculae from RVs, MCT-rats showed lower developed force and lower dF/dt (p&lt;0.01). Correlation between RVLS and dF/dt was higher (n=20, r=0.53, p&lt;0.05) than that between RVEF and dF/dt (r=0.24). In addition, RVLS and dF/dt had already been decreased in 5 MCT-rats with relatively preserved RVEF (&gt;50%), suggesting that RVLS decreases earlier than RVEF in MCT-rats. Ten minutes after the injection of ET-1, RVP was increased from 49.4±7.9 to 57.9±6.4 mmHg in MCT-rats (n=6). In MCT-rats with preserved RVEF and decreased RVLS, the increase in RVP chiefly decreased RVEF while it did not change RVLS and RVEF in Ctr-rats, meaning that RV functional reserve had been decreased in MCT-rats. In trabeculae, developed force and dF/dt were increased after the addition of 0.1 μM ET-1 in MCT- (n=11, p&lt;0.01) and Ctr-rats (n=4, p&lt;0.01).

Conclusion

These results suggest that in rats with PAH, RVLS obtained from CMR can estimate RV functional reserve earlier and more accurately than RVEF. Therefore, RV strain with CMR may become an important parameter to assess RV functional reserve in patients with PAH.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grant-in-Aid for Young Scientists

Differences in Elderly and Non-Elderly Outpatient Subjective Evaluation of "Easy-to-Eat Meals" after Dental Treatment

Dental treatment improves the experience of eating by healing illnesses in the oral cavity or through the installation of special devices. However, mastication can often prove difficult for short periods of time after dental treatment, potentially limiting the types of food that can be consumed. Therefore, we proposed a highly nutritious meal strategy for dental outpatients (hereafter, "easy-to-eat meals"). We previously reported patients' subjective assessment of these easy-to-eat meals as determined through a questionnaire survey. The purpose of the present study was to investigate how differences in age affected such assessments. The study participants comprised patients scheduled to undergo dental treatment. They were divided into 2 groups: one of patients aged above and one of those aged below 70 years. All were required to consume provided easy-to-eat meals at the dental hospital directly after treatment and then answer a questionnaire. The questionnaire included items on patient satisfaction with the meals, taste, portion size, convenience, reduction in discomfort, and whether they would consume them again. The format of the questionnaire was a visual analog scale (VAS), ranging from 0 (negative) to 10 (positive). Portion size was to be rated on a scale from 0 ("Not enough") to 10 ("Too much"), with 5 being "Just right". Correlations between the questionnaire items were investigated to determine how they influenced each other. The VAS average for "Reduction in discomfort" was 8.45±1.39 in the non-elderly group and 6.07±2.92 in the elderly group, and the difference was significant (p=0.02); the VAS average for "Taste" was 6.49±2.32 in the non-elderly group and 4.91±0.98 in the elderly group, and the difference was significant (p=0.04). The results of this study suggest that providing such meal plans as nutritional guidance after dental treatment can influence quality of life in elderly patients.

A comparison of colorimetric and visual methods for the assessment of masticatory performance with color-changeable chewing gum in older persons

Background/purpose

Color-changeable chewing gum is used for the evaluation of masticatory performance. However, it is currently unclear whether colorimetric and visual assessment methods yield consistent results. This study aimed to clarify the consistency between colorimetric and visual methods used for the evaluation of color changes in color-changeable chewing gum.

Materials and methods

The sample comprised 644 older persons (mean age, 75.4 ± 6.4 years). The chewing gum was masticated 60 times at the participant's own chewing rate and then expectorated. The color of the chewing gum was evaluated with the ΔE values and a∗ values, measured using a colorimeter, and the 10 Color Shades (10CSh) and 5 Color Scales (5CSc), using visual evaluation. Spearman's correlation analysis was performed to examine the correlation between the results obtained by the four methods. The significance level was set at α = 0.05.

Results

The ΔE values, a∗ values, 10CSh scores, and 5CSc scores were all significantly correlated. The highest correlation coefficient (0.979) was between the ΔE values and a∗ values. The lowest correlation coefficient (0.847) was between the a∗ values and 5CSc scores. Decreased masticatory performance was observed with increased age.

Conclusion

Significant correlations were found for all four methods used in the assessment of masticatory performance with color-changeable chewing gum. While visually based assessments are valid, colorimetric methods are more sensitive to smaller changes in masticatory performance.

Search for η^{'} Bound Nuclei in the ^{12}C(γ,p) Reaction with Simultaneous Detection of Decay Products

We measured missing mass spectrum of the ^{12}C(γ,p) reaction for the first time in coincidence with potential decay products from η^{'} bound nuclei. We tagged an (η+p) pair associated with the η^{'}N→ηN process in a nucleus. After applying kinematical selections to reduce backgrounds, no signal events were observed in the bound-state region. An upper limit of the signal cross section in the opening angle cosθ_{lab}^{ηp}<-0.9 was obtained to be 2.2  nb/sr at the 90% confidence level. It is compared with theoretical cross sections, whose normalization ambiguity is suppressed by measuring a quasifree η^{'} production rate. Our results indicate a small branching fraction of the η^{'}N→ηN process and/or a shallow η^{'}-nucleus potential.

Intra- and inter-investigator reliabilities of oral moisture measured using an oral moisture-checking device

BACKGROUND

Oral mucosal moisture determined using oral moisture-checking devices is used as a mouth dryness evaluation method. Such devices are capable of evaluating the state of mouth dryness in a simple manner and have applicability in a wide range of subjects; however, their intra- and inter-investigator reliabilities have not yet been clarified.

OBJECTIVE

This study aims to investigate the intra- and inter-investigator reliabilities of measuring oral moisture using an oral moisture-checking device for a wide range of age groups.

METHODS

Intra- and inter-investigator reliabilities were investigated in 28 young subjects and 19 older subjects aged ≥65 years. Three trained investigators independently measured oral mucosal moisture values using an oral moisture-checking device. Intra-investigator reliability was assessed using the coefficient of variation (CV) and intraclass correlation coefficient (ICC) (1.1), and inter-investigator reliability was assessed using ICC (2.1).

RESULTS

Mean CV was 0.015 and 0.016, mean ICC (1.1) was 0.806 and 0.877, and ICC (2.1) was 0.873 and 0.829 in the young and older subjects, respectively.

CONCLUSION

In young subjects, the mean values of ICC (1.1) and ICC (2.1) of the oral moisture-checking device were 0.806 and 0.873, respectively, whereas in older subjects, these values were 0.877 and 0.829, respectively. Thus, this confirms that the examination of oral mucosal moisture using the oral moisture-checking device has sufficient intra- and inter-investigator reliabilities for a wide range of age groups.

"Easy-to-eat Meals" for Outpatients Following Dental Treatment

Patients often experience temporary difficulty in masticating during the period immediately following dental treatment. The purpose of this study was to investigate subjectively assessed satisfaction with a specially designed diet for such patients by means of a questionnaire. These "easy-to-eat meals" were planned and provided by this hospital in Japan, and comprised a combination of commercially available and nutritionally rich soft foods, jellied foods, drinks, and other items. The patients were required to commence consuming them immediately following dental treatment. The questionnaire contained 6 categories -Satisfaction, Taste, Meal completion, Convenience, Reduction in discomfort, and Likelihood of reuse - to be evaluated on a 10-cm visual analog scale (VAS). The overall response was positive in all 41 completed questionnaires, with an overall score of 6 or higher for every category. Orthodontics achieved the highest VAS score in every category, followed by oral implantology, prosthodontics, and conservative Original Article doi:10.2209/tdcpublication.2018-0055 dentistry. A correlation was observed between Satisfaction and each of the 5 remaining questionnaire categories (Taste: |r|=0.70, p≤0.00; Meal completion: |r|=0.60, p≤0.00; Convenience: |r|=0.56, p≤0.00; Reduction in discomfort: |r|=0.48, p=0.00; and Likelihood of reuse: |r|=0.79, p≤0.00). An acceptable level of convenience was obtained with these meals, as they were reported to be useful during the period immediately following treatment, when eating out or preparing meals was physically and/or psychologically difficult.

Comparison of neurosensory devices in detecting cutaneous thresholds related to protective sensibility: A cross-sectional study in São Paulo, Brazil

AIMS

To quantify the static and moving cutaneous sensibility threshold of diabetic patients using a neurosensory device for quantitative pressure detection.

METHODS

Three hundred thirty-four (n = 334) patients with type 2 diabetes and no previous history of wounds on the feet were studied using the one- and two-point static (1SP;2 SP) and one- and two-point moving (1MP;2 MP) tests through the pressure-specified sensory device (PSSD) on the cutaneous territory of the dorsal first web, hallux pulp, and medial calcaneal. In addition, patients were evaluated using the Semmes-Weinstein monofilament (SWM) No. 5.07 and tuning fork (128 Hz), which were used as normality parameters to detect the loss of protective sensibility. The same examinations were used to assess the control group (228 nondiabetic).

RESULTS

Altered values were observed for the static and moving tests over the three studied nerve territories. In comparing the sensibility threshold between diabetic patients who were sensitive and nonsensitive to SWM 5.07, we observed that this filament is not the most indicated for identifying the loss of sensibility in these patients. The prevalence of patients at risk varied between 85 and 89%. The biochemical marker associated with these high rates was HbA1c (p = 0.02).

CONCLUSIONS

Numeric quantification of the pressure threshold allowed us to determine the functional deficit of nerve fibers. Our findings suggest that the neurosensory device should be used as an adjuvant tool to evaluate the degree of loss of sensation on the skin.

Extraskeletal chondrosarcoma in the abdominal cavity of a cow

A 25-month-old female crossbred cow presented with astasia, emaciation, and stunted growth. Macroscopic examination revealed a large mass in the abdominal cavity, approximately 100 × 30 × 30 cm. Microscopic examination revealed that the mass consisted of multilobular mature and immature cartilaginous matrices with chondrocytic cells, surrounded by spindle to pleomorphic mesenchymal tumor cells. The cartilaginous matrices consisted of hyaline and elastic cartilages, as confirmed with Azan stain, and Victoria Blue and Van Gieson stain. Immunohistochemistry revealed that the chondrocytic and mesenchymal cells both expressed S-100. The tumor was diagnosed as an extraskeletal chondrosarcoma in the abdominal cavity of this cow.

P5626The clinical impact of the angle of OCT detected irregular protrusion after primary PCI at the STEMI culprit lesions

Background and introduction

The percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) shows worse clinical outcomes than that for stable angina. As the one of the reasons, a recent optical coherence tomography (OCT) registry showed that the presence of irregular protrusion (IP)after coronary stenting was the worse predictor of 1-year device-oriented clinical end points. However, the impact of the quantitative findings on IP has not been well investigated in ACS patients.

Aim

To investigate the clinical impact of the post stent OCT findings, especially IP, detected by OCT after coronary stenting in ACS patients.

Methods

Consecutive 256 ACS lesions treated with OCT-guided PCI in our Medical University Hospital from January 2013 to November 2016 was retrospectively analyzed. In 256 lesions, 173 lesions were enrolled which had ST-elevation acute myocardial infarction (STEMI) with the onset to recanalization time within 720 minutes. In 170 lesions, the OCT images were available. In OCT image, IP was detected in 140 lesions (82.3%). Quantitative analysis of IP in post-procedure OCT imaging was observed to identify the OCT predictors for clinical endpoint including cardiac death, target vessel revascularization ant stent thrombosis in 1 year after index PCI.

Result

In post-procedure OCT findings, stent edge dissection was detected in 32.4% of lesions. Incomplete stent apposition was detected in 74.1%. Maximum angle of irregular protrusion was 194±86 degree and the incidence of maximum IP angle >180 degree was 52.9%. Maximum height of IP was 0.26±0.11mm. Small minimal stent area, defined as a lesion with minimal stent area <5.0 mm2 in a drug-eluting stent or <5.6 mm2 in a bare metal stent, was observed in 32.4% of lesions. Maximum IP angle and that of >180degree was significantly associated with the clinical endpoint (p=0.0259 and 0.0429, respectively).

Conclusion

In STEMI patients, IP was frequently observed in post-procedure OCT imaging during primary PCI. The maximum angle of IP was significantly associated with the clinical end points. The prognostic impact of maximum IP angle in STEMI patient needs further investigations.

P3579Clinical characteristics of an intracoronary erosion and thrombus in patients with vasospastic angina

Background

Intracoronary erosion and thrombus are sometimes detected in patients with vasospastic angina (VSA) through intracoronary imaging modalities. However, the clinical characteristics of these intracoronary findings remain unclear. Therefore, we assessed the clinical and lesion characteristics of these intracoronary abnormalities in patients with VSA.

Methods

We included 48 patients with VSA who underwent coronary angiography (CAG), spasm provocation test (SPT), and coronary angioscopy (CAS). In all patients, acetylcholine was infused in the left and right coronary arteries. The vessels were classified into spastic vessels (SVs) and non-spastic vessels (NSVs) based on SPT results. SVs that could not be observed using CAS were excluded from the study. CAG and SPT findings were evaluated for the presence of atherosclerotic lesions (%stenosis <30%) and types of spasm (segmental or diffuse). Two experts examined the presence of an intracoronary erosion and thrombus on CAS. Other serious symptoms such as cold sweating or syncope were also assessed.

Results

Among the 48 patients, intracoronary erosion and thrombus were detected in 11 (23%) and 10 (21%) patients, respectively, and total intracoronary abnormalities were observed in 17 (35%) patients. Male sex (p<0.05), smoking (p<0.05), and presence of other serious symptoms (p<0.01) were associated with the presence of intracoronary abnormalities. The logistic regression analysis showed the presence of other serious symptoms to be the only factor associated with the presence of intracoronary abnormalities (p<0.05). In the lesion analyses, among the 72 vessels, intracoronary abnormalities were observed only in SVs (17/53, 33%) but not in NSVs (0/19, 0%, p<0.01). Among the 53 SVs, the presence of atherosclerotic lesions (p<0.05) and segmental spasm type (p<0.05) were found to be associated with the presence of intracoronary abnormalities.

Conclusions

Intracoronary erosion and thrombus were observed in approximately 35% of patients with VSA. Such intracoronary abnormalities may be partly affected by the forms of the coronary artery and coronary spasm, leading to the onset of serious symptoms of VSA.

Morphological Investigation of Residual Ridge in Japanese Edentulous Elderly for Fabrication of Edentulous Stock Tray

The objective of this study was to determine the size of the residual ridge in edentulous elderly Japanese persons for preparation of edentulous stock trays and clarify any correlations among the items measured. The participants comprised 74 patients requesting construction of a complete denture for the maxilla, mandible, or both. The length, width, and anterior and posterior height of the maxillary and mandibular residual ridge was measured on a prepared working model using a caliper. For each of the maxillary and mandibular edentulous residual ridges, correlations among measurement items were analyzed employing Pearson's correlation coefficient. In participants who were edentulous in both the maxilla and mandible, correlations between the maxillary and mandibular measurement items were analyzed employing Pearson's correlation coefficient. The results revealed that the mean maxillary length of the residual ridge was 55.21±4.07 mm, while mean mandibular length was 56.03±4.04 mm. The mean posterior width of the maxillary jaw was 48.79±4.14 mm, while that of the mandibular jaw was 57.33±3.24 mm. A strong correlation was found between the length and width of the residual ridge in both the maxilla and mandible, but no strong correlation was detected between the height in the anterior tooth region and any other item measured. These findings suggest that the size of any given item can be estimated by measuring either the length or width of the residual ridge when selecting a stock tray. We also propose that it is necessary to prepare stock trays with several different heights in the anterior tooth region, regardless of the length and width of the tray, or to adjust the length of the tray.

Evaluation of Factors Associated with Tongue Coating Status in Elderly with Care Needs

The tongue surface in older people requiring nursing care is often coated with a layer believed to comprise, keratinized products of degeneration, food residue, bacteria, and leukocytes attached to the tongue papillae. Which factors affect the status of this tongue coating remain to be elucidated, however. The purpose of this study was to evaluate factors related to tongue coating status in older people requiring nursing care. The study participants comprised 41 individuals admitted to special nursing homes for the elderly. After undergoing tooth brushing and tongue cleaning by the facility staff, the participants were required to refrain from oral cleaning until evaluation of tongue coating status, which was performed just after lunch. The moisture level of the tongue surface was measured and total number of oral microbes determined. Food type, care level, and sex were determined by a questionnaire given by the attending nurses. Correlations between the tongue coating status and various factors were analyzed using Spearman's rank correlation coefficient. The participants were divided into 2 groups according to the median value of the tongue coating status. Factors related to tongue coating were analyzed using binomial logistic regression analysis (α=0.05). Tongue coating status showed a significant correlation with the total number of oral microbes on the tongue surface (r_S=0.449, p=0.003), type of food (r_S=0.388, p=0.012), and care level (r_S=-0.308, p=0.050). Logistic regression analysis revealed that the food type of the side dish significantly affected tongue coating status. These results showed a correlation between tongue coating status and type of food of the side dish in older people requiring nursing care.

Change in Autonomic Nervous Activity during Ingestion of Soft Food in Older Nursing Home Residents

The deterioration in masticatory function often seen in older adults rules out the consumption of hard foods, while a common decline in autonomic nervous response often observed in older adults may result in maladjustment to environmental stresses. The purpose of this study was to investigate whether autonomic nervous activity in older adults increased during the mastication of soft foods compared to at rest. The participants comprised 9 volunteer nursing home residents aged 78 to 100 years. All consumed soft rice as a grain dish and coarsely chopped food as side dishes. The coefficient of variation of R-R intervals (CVRR) and high-frequency (HF) power on electrocardiograph (ECG) served as indices of parasympathetic nervous activity, while the low-frequency (LF)/HF ratio served as an index of sympathetic nervous activity. Total power, reflecting the level of autonomic nervous activity, was also measured. We measured autonomic nervous activity while nursing home residents were eating lunch. HF was 3,457.4±3,037.5 ms² at rest and 4,085.1±3,697.7 ms² during mastication. The CVRR was 26.8±16.9% at rest and 26.1±16.1% during mastication. No significant difference was observed in HF or CVRR. On the other hand, the LF/HF ratio was 0.77±0.24 ms² at rest and 31.0±3.77 ms² during mastication (p=0.011). A significant difference was observed in the LF/HF ratio between the resting and masticating conditions. Total power was 6,244.1±5,752.5 ms² at rest and 8,417.7±7,266.4 ms² during mastication (p=0.038). A significant difference was also observed in total power between resting and masticating conditions. These results suggest that mastication of soft foods stimulates autonomic nervous activity in older adults. In conclusion, autonomic nervous activity increased during chewing soft foods compared to that during the resting level in older adults.

Two-year Survey of Trends at Food Introduction Booth at Suidobashi Hospital of Tokyo Dental College

A working group established at Tokyo Dental College Suidobashi Hospital considered how to manage patients experiencing difficulties with food intake during the process of dental treatment. This resulted in the opening of an in-hospital booth dedicated to providing advice on such problems. A survey was performed to determine the number of patients utilizing this facility and the department which they were attending with the aim of investigating factors involved in eating-related problems. The results revealed that patients were being referred to the booth from the departments of dental prosthetics, conservative dentistry, oral and maxillofacial surgery (by both dentists and dietitians), oral implantation, and orthodontics. Patients were provided with information on the booth by their dentist or dietician, either by means of introductory materials or verbally. These patients were requested to complete a questionnaire, with informed consent, over a 2-year period. The participants were classified according to age and original dental problem on attending this hospital and the results analyzed. The inability to eat hard foodstuffs, difficulty in chewing, inability to open the mouth, insufficient nutrition, unbalanced nutrition, intraoral pain, and difficulty in swallowing were all identified as problems related to eating. A total of 1,948, 413 visitors had received introductory materials, while 156 had learned of the facility verbally. Looking at department as a factor, the inability to eat hard foodstuffs and difficulty chewing occupied a large percentage of the reported problems for all departments. Taken together, these results revealed that many patients experienced difficulties in eating during the process of treatment. This indicates that it is necessary to give the appropriate eating instructions to each patient according to their specific needs and stage of dental treatment.