The psychological effects of COVID-19 on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship

The aim of the present study was to investigate the psychological effects of the COVID-19 outbreak and associated factors on hospital workers at the beginning of the outbreak with a large disease cluster on the Diamond Princess cruise ship. This cross-sectional, survey-based study collected demographic data, mental health measurements, and stress-related questionnaires from workers in 2 hospitals in Yokohama, Japan, from March 23, 2020, to April 6, 2020. The prevalence rates of general psychological distress and event-related distress were assessed using the 12-item General Health Questionnaire (GHQ-12) and the 22-item Impact of Event Scale-Revised (IES-R), respectively. Exploratory factor analysis was conducted on the 26-item stress-related questionnaires. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes for workers both at high- and low-risk for infection of COVID-19. A questionnaire was distributed to 4133 hospital workers, and 2697 (65.3%) valid questionnaires were used for analyses. Overall, 536 (20.0%) were high-risk workers, 944 (35.0%) of all hospital workers showed general distress, and 189 (7.0%) demonstrated event-related distress. Multivariable logistic regression analyses revealed that 'Feeling of being isolated and discriminated' was associated with both the general and event-related distress for both the high- and low-risk workers. In this survey, not only high-risk workers but also low-risk workers in the hospitals admitting COVID-19 patients reported experiencing psychological distress at the beginning of the outbreak.

Effect of eicosapentaenoic acid/docosahexaenoic acid on coronary high-intensity plaques detected with non-contrast T1-weighted imaging: subgroup analysis of the AQUAMARINE EPA/DHA study

Background

In the recent the Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT), statin therapy plus high-dose eicosapentaenoic acid (EPA) significantly reduced the risk of cardiovascular death in patients with coronary artery disease (CAD) with elevated triglyceride (TG) levels. An epidemiologic study has shown that increasing the intake of long-chain n-3 polyunsaturated fatty acids, especially EPA and docosahexaenoic acid (DHA), are associated with a lower risk of fatal CAD. However, the anti-atherosclerotic effect of high-dose EPA/DHA has not be clarified.

We reported that coronary high-intensity plaques (HIPs) detected with non-contrast T1-weighted imaging (T1WI) on cardiac magnetic resonance (CMR), which can be uniquely quantitative assessed using the plaque-to-myocardium signal intensity ratio (PMR) of ≥1.4, are significantly associated with future coronary events. Moreover, we demonstrated that intensive statin therapy reduces the PMR of coronary HIPs by 19% but is unlikely to completely resolve HIP (PMR<1.0).

In the AQUAMARINE EPA/DHA study, our goal was to assess the anti-atherogenic effect of EPA/DHA in an exploratory manner by examining the change in PMR of coronary HIPs after 12 months of EPA/DHA therapy in patients with CAD on statin therapy.

Methods

This study was designed as a single-center, triple-arm, parallel-group, randomized controlled, open-label, superiority trial examining the effect of 12 months of additional EPA/DHA therapy on coronary HIPs in patients with CAD who receiving statin therapy. Eligible subjects are randomly assigned to the 2 g/day EPA/DHA group (n=26), the 4 g/day group (n=23), or the no EPA/DHA (statin-only) group (n=24) between May 2014 and December 2017. The PMR was defined as the signal intensity of the coronary plaque divided by that of nearby left ventricular myocardium. The primary endpoint is the change in PMR after EPA/DHA treatment.

Results

These 3 groups were well matched at baseline, with no statistically significant differences in age, male sex, conventional coronary risk factors, TG level, medications, and PMR. Figure 1 shows subgroup analysis of patients with high triglyceride levels (>150mg/dl). In the patient-based analysis (A), 12 months of EPA/DHA therapy significantly reduced the PMR of primary lesions. In the segment-based analysis (B), additional reduction of PMR was observed in the high-dose EPA/DHA group compared with the no EPA/DHA treatment group.

Discussion

The present study of patients with high triglyceride levels demonstrated that EPA/DHA had a dose-dependent anti-atherosclerotic effect. This finding may provide additional information of EPA/DHA for lowering the residual risk in patients with CAD on statin therapy.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Takeda Pharmaceutical Co., Ltd.

FRI0623-HPR HEALTHCARE RESOURCE USE IN PATIENTS WITH TRAPEZIOMETACARPAL OSTEOARTHRITIS

Background:

Trapeziometacarpal osteoarthritis (TMO) is one of the most debilitating forms of hand osteoarthritis (OA). According to the recent EULAR guidelines1, 2and a systematic review,3the efficacy of topical/oral non-steroid anti-inflammatory drugs (NSAIDs), orthoses, hand exercises, and psychosocial interventions for hand OA or TMO are supported by scientific evidence. Cortisone injections and acetaminophen are generally not recommended.1, 3Besides, TMO management is suboptimal: only 21% of patients receive rehabilitative interventions prior to referral to hand surgeons.4

Objectives:

We aimed at documenting the types of treatment TMO patients employ and their healthcare resource use.

Methods:

A total of 227 TMO patients recruited from 16 healthcare institutions completed a questionnaire about 1) received interventions, 2) analgesic strategies, and 3) healthcare professional consultations.

Results:

Acetaminophen (64.3% of the participants), oral NSAIDs (31.7%), topical NSAIDs (11.9%), and nutraceuticals (7.9%) were the most commonly used medications. More than 70% of the participants reported having received cortisone injection(s) (72.5%) and orthosis (75.7%). More than half employed hand exercises, massage and heat/cold application. Relaxation/respiration, meditation, distraction, assistive devices, and joint protection principles were used by smaller percentages of participants (13.0-30.9%). Patients with TMO reported having consulted various types of healthcare professionals: family physicians, plastic/orthopaedic surgeons, radiologists-interventionists, rheumatologists, physiatrists, occupational/physical therapists, osteopaths, chiropractors, pharmacists, and acupuncturists. Only 4.8% of the participants reported having received psychosocial interventions.

Conclusion:

TMO patients use numerous types of modalities to relieve their pain. Provision of evidence-based interventions tailored to their needs is clearly needed.

References:

[1] Kloppenburg M, Kroon FP, Blanco FJ, et al. 2018 update of the EULAR recommendations for the management of hand osteoarthritis.Annals of the rheumatic diseases.2019;78:16-24.

[2] Geenen R, Overman CL, Christensen R, et al. EULAR recommendations for the health professional’s approach to pain management in inflammatory arthritis and osteoarthritis.Annals of the rheumatic diseases.2018;77:797-807.

[3] Hamasaki T, Laprise S, Harris PG, et al. Efficacy of non-surgical interventions for trapeziometacarpal (thumb base) osteoarthritis: A systematic review.Arthritis Care & Research.2019; In press (https://doi.org/10.1002/acr.24084).

[4] Gravås EMH, Tveter AT, Nossum R, et al. Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study.BMC musculoskeletal disorders.2019;20:180-180.

Acknowledgments:

This study was supported by a discretionary fund of the Centre de recherche du CHUM (CRCHUM) to Choinière and from the

Multidisciplinary Council of the CHUM. Hamasaki was supported by a Doctoral training award of the Fonds de recherche du Québec—Santé, a doctoral scholarship from the CHUM Foundation to Harris (Hand Surgery Branch) and from Choinière’s internal funds of the CRCHUM.

Disclosure of Interests:

None declared

FRI0608-HPR SEVERITY AND PREDICTORS OF PAIN INTENSITY AND HAND DISABILITY IN PATIENTS WITH TRAPEZIOMETACARPAL OSTEOARTHRITIS

Background:

Trapeziometacarpal osteoarthritis (TMO) is one of the most prevalent and painful forms of hand osteoarthritis.1It limits thumb mobility,2reduces hand functions, and manual activities.1Yet, no study has exhaustively documented the characteristics of this pathology using a biopsychosocial approach (e.g., pain, disability, psychological well-being, pain-related catastrophic thinking, quality of life). Furthermore, radiographic TMO severity and symptomatology are only weakly to moderately correlated.3, 4The extent to which biopsychosocial factors (e.g., pain duration, depression, education) contribute to interindividual variability in TMO pain and hand disability merits further investigation.

Objectives:

This study aimed at 1) describing the pain experience of patients with trapeziometacarpal osteoarthritis (TMO) from a biopsychosocial perspective, and 2) identifying predictors of their pain intensity and hand disability.

Methods:

A total of 227 TMO patients recruited from 16 healthcare institutions completed validated questionnaires assessing their biopsychosocial characteristics. The associations of pain severity and hand disability with various biopsychosocial characteristics were analyzed by linear regression.

Results:

The participants’ mean age was 62.6 ± 8.5 years and 78% were women. Their mean pain intensity on the average in the last seven days was 5.8 ± 2.1 while their hand disability scores averaged 45.4 ± 18.8 on the QuickDASH. In terms of health-related quality of life, the participants’ scores on the physical and mental summary scales of the SF-12v2 were 41.0 ± 9.4 and 48.7 ± 9.7 respectively. Results of the multivariable linear regression analyses revealed that age, living condition, pain frequency, pain-related catastrophic thinking, and depression levels accounted for 43.3% of the variance in pain intensity while age, sex, pain intensity, pain-related catastrophic thinking, depression, level of education, employment status and living condition accounted for 60.6% of the variance in hand function.

Conclusion:

This comprehensive study showed that patients with TMO experience pain of moderate to severe intensity which can affect various aspects of their daily living and their physical health-related quality of life. Greater tendency to catastrophize in the face of pain and higher depression levels were associated with more severe pain suggesting that psychological interventions aiming at reducing these factors could be beneficial for some patients with TMO.

References:

[1] Bijsterbosch J, Visser W, Kroon HM, Stamm T, Meulenbelt I, Huizinga TW, Kloppenburg M. Thumb base involvement in symptomatic hand osteoarthritis is associated with more pain and functional disability.Annals of the rheumatic diseases.2010;69:585-587.

[2] Gehrmann SV, Tang J, Li ZM, Goitz RJ, Windolf J, Kaufmann RA. Motion deficit of the thumb in CMC joint arthritis.Journal of hand surgery.2010;35:1449-1453.

[3] Botha-Scheepers S, Riyazi N, Watt I, Rosendaal FR, Slagboom E, Bellamy N, Breedveld FC, Kloppenburg M. Progression of hand osteoarthritis over 2 years: a clinical and radiological follow-up study.Annals of the rheumatic diseases.2009;68:1260-1264.

[4] Hwang RW, Ring D. Pain and disability related to osteoarthrosis of the trapeziometacarpal joint.J Hand Microsurg.2011;3:63-65.

Acknowledgments:

This study was supported by a discretionary fund of the Centre de recherche du CHUM (CRCHUM) to Choinière and from the Multidisciplinary Council of the CHUM. Hamasaki was supported by a Doctoral training award of the Fonds de recherche du Québec—Santé, a doctoral scholarship from the CHUM Foundation to Harris (Hand Surgery Branch) and from Choinière’s internal funds of the CRCHUM.

Disclosure of Interests:

None declared

Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta-analysis

BACKGROUND

Although recombinant human soluble thrombomodulin (rhTM) is a widely used novel anticoagulant agent for disseminated intravascular coagulation (DIC) in Japan, its clinical efficacy in sepsis-induced DIC has not been demonstrated convincingly.

OBJECTIVE

To assess the benefits and harms of rhTM in sepsis-induced DIC patients.

METHODS

We conducted a systematic review and meta-analysis of rhTM therapy for sepsis-induced DIC for both randomized controlled trials (RCTs) and observational studies (retrospective case-control studies and/or prospective cohort studies) separately. All-cause mortality (28-30 days) as efficacy and serious bleeding complications as adverse effect were measured as primary outcomes. We assessed body of evidence quality at the outcome level by using the Grading of Evidence, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

We analyzed 12 studies (838 patients/3 RCTs; 571 patients/9 observational studies). Pooled relative risk was 0.81 (95% CI, 0.62-1.06) in the RCTs, indicating non-significant reduction in mortality, and 0.59 (95% CI, 0.45-0.77) in the observational studies. Meta-regression analysis revealed a significant negative slope between effect size of rhTM therapy and baseline mortality rate in individual studies (P = 0.012), suggesting that probability of a beneficial effect with rhTM therapy increases with increasing baseline risk. Risk of serious bleeding complications was not significantly different between rhTM and control groups. We judged the quality of evidence as moderate for mortality and serious bleeding.

CONCLUSIONS

The rhTM was associated with a trend in reduction of mortality at 28-30 days in sepsis-induced DIC patients. Further large rigorous trials are needed to confirm or refute these findings before implications for practice are clear.

Prognostic factors for survival in cervical cancer patients with bone metastasis

PURPOSE

To investigate the prognostic factors for survival in uterine cervical cancer patients who developed bone metastasis.

MATERIALS AND METHODS

Cervical cancer patients with bone metastasis who were treated at the present institute from April 1996 to September 2010 were identified from the authors' institutional tumor registries. Primary disease, follow-up, and recurrence data were collected and retrospectively reviewed. Univariate and multivariate analyses of prognostic factors for survival were performed.

RESULTS

A total of 37 patients that developed cervical cancer bone metastasis were included in the authors' database. The median survival time after recurrence was 12 months. Univariate analysis revealed that patients with a disease-free interval (DFI) of ten months or less achieved significantly shorter survival after bone metastasis detection than those with a DFI of 11 months or more (median: 8.5 months versus 17 months, p < 0.0001). Multivariate analysis also showed that DFI of ten months or less was a significant predictor of short survival (p = 0.0018).

CONCLUSIONS

The DFI was found to be independent prognostic factors for survival in cervical cancer patients who developed bone metastasis.

How regular visits and preventive programs affect onset of adult caries

If it is to be effective, preventive dental treatment must be based on an individual's risk of caries and periodontal disease. However, hitherto, preventive treatment has been generally conducted without proper caries-risk assessment because of lack of knowledge about an individual's caries risk. This study sought to identify high-risk adult patients and examine the effectiveness of preventive programs. Data for 442 patients from a single general practice who met the inclusion criteria were analyzed. Multiple logistic-regression analysis showed that high levels of mutans streptococci (SM) correlated with the onset of primary and secondary caries, with odds ratios of 2.34 (95%CI: 1.15-4.76, p = 0.019) and 2.22 (95%CI: 1.06-4.62, p = 0.034), respectively. Lactobacilli (LB) also correlated with secondary caries, with an odds ratio of 3.34 (95%CI: 1.35-6.85, p = 0.007). When the patients were checked after three years of a preventive program, the correlation with SM and LB disappeared. Survival analyses by Cox regression models and Kaplan-Meier methods showed that secondary caries was difficult to control by conventional preventive programs alone in patients with high levels of cariogenic bacteria. In conclusion, cariogenic bacteria play an important role in the incidence of caries, and additional intensive preventive treatment should be considered for high-risk patients.

Applicability of both dentist and patient perceptions of dentists' explanations to the evaluation of dentist-patient communication

OBJECTIVES

Very little is known about dentist-patient communicative behaviours in actual practice. This study evaluated dentist and patient perceptions of dentist-patient communication and patient outcome.

PARTICIPANTS

The subjects were 171 dentist-patient pairs in Kitakyushu, Japan.

RESEARCH DESIGN

Dentists and patients answered the same questionnaire items using the same response categories to evaluate dentist-patient communication. Based on the scores of patient and dentist perceptions with respect to dentist-patient communication, patient-dentist pairs were categorised into one of 3 groups. Data analyses used one-way ANOVA, multiple linear regression analysis, and multiple logistic regression analysis.

RESULTS

We found that, with respect to dentist-patient communication, patients in the 'patient better' group (i.e., the patient's evaluation was more positive than the dentist's evaluation) were more likely to have a positive outcome (e.g., 'improvement of health and fear,' 'satisfaction with care') than those in the other two groups. Patients in the 'doctor better' group (i.e., the dentist's evaluation was the more positive) were more likely to have a negative outcome than those in the other two groups.

CONCLUSIONS

A positive patient outcome is more likely when the patient's evaluation is better than a dentist's evaluation with respect to dentist-patient communicative behaviours. The method based on patient and dentist perceptions with respect to dentist-patient communication might be effective in evaluating dentist-patient communication.

Purification and Characterization of O-Methyltransferase I Involved in Conversion of Demethylsterigmatocystin to Sterigmatocystin and of Dihydrodemethylsterigmatocystin to Dihydrosterigmatocystin during Aflatoxin Biosynthesis

O-Methyltransferase I, which catalyzes conversions both of demethylsterigmatocystin (DMST) to sterigmatocystin (ST) and of dihydrodemethylsterigmatocystin (DHDMST) to dihydrosterigmatocystin (DHST) during aflatoxin biosynthesis, was purified to apparent homogeneity from the cytosol fraction of the mycelia of Aspergillus parasiticus NIAH-26 through the following chromatography series: phenyl-Sepharose, DEAE-Sepharose, phenyl-Sepharose, Sephacryl S-300, and Matrex gel Green A. The apparent molecular mass was estimated at 150 kDa based on Sephacryl S-300 gel filtration chromatography, and the denaturing molecular mass was 43 kDa based on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The pI of the enzyme was 4.4, and the optimal pH for activity was broad, from 6.5 to 9.0. In competition experiments using the purified enzyme, the formation of ST from DMST was suppressed when DHDMST was added to the reaction mixture and DHST was newly formed. These results indicate that DMST and DHDMST commonly serve as substrates for the enzyme. The K(m) of the enzyme for DMST was 0.94 muM, and that for DHDMST was 2.5 muM. Interestingly, MT-I kinetics deviated substantially from standard Michaelis-Menten kinetics, demonstrating substrate inhibition at a higher substrate concentration.

Purification and characterization of two versiconal hemiacetal acetate reductases involved in aflatoxin biosynthesis

Two versiconal hemiacetal acetate (VHA) reductase activities (designated I and II), which catalyzed the reaction from VHA to versiconol acetate (VOAc) during aflatoxin biosynthesis, were purified to apparent homogeneity from the cytosol fraction of the mycelia of Aspergillus parasiticus mutant NIAH-26 through the following chromatography steps: first, fractionation with ammonium sulfate and then fractionation in succession with phenyl-Sepharose, DEAE-Sepharose, Sephacryl S-300, hydroxylapatite, and Matrex gel Green A chromatography. VHA reductase I and VHA reductase II were completely separated at the end of the DEAE-Sepharose step. The apparent molecular masses of reductase I and reductase II were estimated (by gel filtration) to be approximately 390 kDa; their denaturing molecular masses were 39- and 40-kDa, respectively (by sodium dodecyl sulfate-polyacrylamide gel electrophoresis). Their pI values were 6.6 and 6.0, respectively (as determined by isoelectric focusing), and the optimal pH values were 8.0 and 9.0, respectively, although both enzymes exhibited a broad optimal pH range of between 7.5 and 9.0. The K(m) values of reductase I and reductase II for VHA were 35.4 and 25.4 muM, respectively. On the other hand, in the cell-free experiments involving either VHA reductase fraction and high-performance liquid chromatography, both (2'S)- and (2'R)-VOAc enantiomers were formed from racemic VHA and more of the 2'R isomer than the 2'S isomer was produced, indicating that the VHA reductase fractions have very similar stereospecificities to the substrate.

Reduced carotid atherosclerosis in asthmatic patients treated with inhaled corticosteroids

Although inflammation is an important component of atherosclerosis, it is unknown whether inhaled corticosteroids (ICS) as anti-inflammatory drugs prevent atherosclerosis. In the present study, carotid atherosclerosis was evaluated by ultrasonography in 150 asthmatic patients who had been regularly treated with ICS, and in 150 matched nonasthmatic controls, with an assessment of atherosclerotic risk factors. Carotid intima-media thickness was significantly lower in the asthmatic patients than in the controls. The prevalence of carotid plaque tended to be lower in the asthmatic patients than in the controls. Defined carotid atherosclerosis was diagnosed in 51 of the asthmatic patients, who were older, with a higher prevalence of males, a higher prevalence of dyslipidaemia and a lower mean daily dose of ICS than the 99 patients without carotid atherosclerosis. Stepwise multiple logistic regression analysis identified age, male sex and dyslipidaemia as positive risk factors for carotid atherosclerosis. The mean daily dose of ICS was a negative risk factor. Carotid atherosclerosis is reduced in asthmatic patients treated with ICS compared with matched controls. This study suggests that ICS may have protective effects against atherosclerosis.

Number of teeth and serum lipid peroxide in 85-year-olds

OBJECTIVES

To investigate influence of dental status on systemic oxidative stress, we evaluated the association between number of teeth and serum lipid peroxide, an oxidative stress index, in 85-years old residents of Japan.

METHODS

In October 2003, 207 subjects 85-years old agreed to participate in the present follow-up study after five years from the 8020 Data Bank Survey of Fukuoka prefecture in 1998. Dental health condition including number of teeth was examined by dentists. Data from 204 subjects (88 male, 116 female) who completed nonfasting venous blood examination including lipid peroxide and blood chemistry were analyzed. The examination included a medical questionnaire regarding smoking history, physical activity, alcohol consumption, educational duration, and regular dental care, anthropometric and manometric measurements.

RESULTS

Albumin, lipids, and lipid peroxide in serum all were within the normal range. Number of teeth correlated positively with height and white blood cell count, and correlated negatively with lipid peroxide. In a multiple regression analysis to adjust for confounding factors, tooth number retained this correlation with lipid peroxide. By analysis of variance with a Bonferroni-Dunn correction, edentulous subjects showed significantly higher lipid peroxide than those retaining 20 teeth or more.

CONCLUSION

The negative association between number of teeth and lipid peroxide links more teeth remaining with less oxidative stress in an 85-year-old population; this may decrease risk of atherosclerotic complications.

Oral health and mortality risk from pneumonia in the elderly

Although poor oral health influences the occurrence of pulmonary infection in elderly people, it is unclear how the degree of oral health is linked to mortality from pulmonary infection. Therefore, we evaluated the relationship between oral health and four-year mortality from pneumonia in an elderly Japanese population. The study population consisted of 697 (277 males, 420 females) of the 1282 individuals who were 80 years old in 1997. Data on oral and systemic health were obtained by means of questionnaires, physical examinations, and laboratory blood tests. One hundred eight of the study persons died between 1998 and 2002. Of these, 22 deaths were due to pneumonia. The adjusted mortality due to pneumonia was 3.9 times higher in persons with 10 or more teeth with a probing depth exceeding 4 mm (periodontal pocket) than in those without periodontal pockets. Therefore, the increase in teeth with periodontal pockets in the elderly may be associated with increased mortality from pneumonia.

[Mediastinal abdominal wall fistula due to ePTFE membrane]

A 78-year-old woman who had undergone double valve replacement 13 years before was referred to our department because of postoperative wound dehiscence and exudate. Although the result of exudate culture was negative, the wound was disinfected continuously for 4 weeks and showed a transient remission. However, the exudate was observed again 3 weeks later. By chest computed tomography (CT), a highly bright shadow was revealed in the mediastinum, which was suspected to be a foreign body and, therefore, the cause of the exudate. Considering the possibility of infection, the patient underwent an operation. Following incision of the epigastric region and the resection of the xiphoid process, ePTFE membrane with poor granulation tissue was found. The membrane was removed, the lesion was washed with warm saline, and then the wound was closed. The postoperative course was uneventful without recurrence. This complication was considered to be caused by biological reaction to a foreign body.

Relationship between chewing ability and 4-year mortality in a cohort of 80-year-old Japanese people

OBJECTIVE

Poor oral health has been reported to be a risk indicator of mortality, however, few data are available regarding the relationship between chewing ability and mortality. We examined the relationship between self-assessed chewing ability and mortality in elderly subjects.

DESIGN

Prospective study.

SUBJECTS AND METHODS

Participating in the study were 697 people (277 males, 420 females) from 1282 individuals (80 years old) residing in Fukuoka Prefecture, Japan. Data on oral and systemic health status through questionnaires, accompanied by physical and laboratory blood examinations were obtained. Chewing ability was assessed based on the number of types of food each subject reported as able to chew by questionnaire.

RESULTS

A total of 108 subjects died between 1998 and 2002. Those with the lowest number of chewable foods were associated with higher risk of mortality than those with the ability to chew all of the 15 types of food surveyed [hazard ratio (HR) = 2.38, 95% confidence interval (95% CI) = 1.07-5.29], though other parameters including current smoking, low serum albumin, and poor physical health status were more significant. Further, reduced chewing ability of soft foods increased the risk (HR = 2.65, 95% CI = 1.20-5.87).

CONCLUSION

Chewing ability was associated with mortality in a population of 80-year-old community residents, and may be a predictor for survival rate.

Rapid disease progression correlates with instability of mutant SOD1 in familial ALS

Studies on the clinical course of familial ALS suggest that the duration of illness is relatively consistent for each mutation but variable among the different mutations. The authors analyzed the relative amount of mutant compared with normal SOD1 protein in the erythrocytes from 29 patients with ALS with 22 different mutations. Turnover of mutant SOD1 correlated with a shorter disease survival time.

Relationship of number of remaining teeth to health-related quality of life in community-dwelling elderly

OBJECTIVE

The aim of this study was to evaluate the relationship between number of remaining teeth and health-related quality of life in community-dwelling elderly.

SUBJECTS

A total of 207 participants who were community-dwelling, 85 years of age. Data were from a population-based study of age-related general and oral health in Fukuoka Prefecture, Japan.

MEASUREMENTS

The Japanese version of the Short Form 36 Health Survey (SF-36).

RESULTS

The mental component score for the participants, from the SF-36, was higher than the Japanese national norm for those aged > or = 70 years. There were no significant differences in the mean of any scores on the SF-36 by having spouse, living with family, or education level. The mean of the SF-36 scores of physical functioning (PF) and of the physical component scores were significantly higher in the 85-year-old participants with > or = 20 teeth than in those with < or = 19 teeth (p < 0.05 and p < 0.01 respectively). In addition, a significant difference (p < 0.05) was observed between the mean of participants with > or = 20 teeth and those with < or = 19 teeth after adjustment for region where the participant lived, activities of daily living (ADL), and sex. The PF (p < 0.001), role-physical (p < 0.005), bodily pain (p < 0.001), vitality (p < 0.001), social functioning (p < 0.05), and physical component (p < 0.001) scores were significantly higher in participants with a good activities of daily living (ADL) assessment. However, ADL was not associated with the number of teeth.

CONCLUSIONS

The findings of the present study indicated that 85-year-old participants with > or = 20 teeth had better subjective physical health than those with < or = 19 teeth.

Quantification of dioxin in the sieved fraction of river sediment

Dioxin pollution of aquatic sediments has been one of the important environmental problems in Japan. Grain size distribution and organic constituents may play important roles in dioxins contents in sediments, which have not been well investigated. This paper aims to quantify dioxins (PCDDs/Fs and co-PCBs) in sieved surface sediment fractions obtained from Kizu and Sumiyoshi Rivers in Osaka, Japan. The samples were prepared and analyzed following the 'Manual of the Survey and Measurement of Dioxins in Sediment' (Environment Agency of Japan, 2000). The results showed that TEQ concentrations of dioxins increased with decreasing grain size in sediment fractions. Sediment fractions with less than 20 microm grain size showed the highest dioxin contents. Dioxins with five and six chlorine atoms dominated other congeners in less than 20 microm fractions. The dioxin TEQ concentrations increased with total organic carbon (TOC), total carbon (TC), ignition loss (IL), total sulphur and nitrogen contents in the sediment fractions. Thus, reporting dioxin contents in sediments without considering grain size distribution may be erroneous, and conventional sedimentation and separation techniques might not be useful for treating contaminated sediments. This information can be useful for effective remediation of dioxin-contaminated sediments.

The assessment of methyl mercaptan, an important clinical marker for the diagnosis of oral malodor

OBJECTIVE

This study aimed to determine the clinical assessment of volatile sulfur compound (VSCs) for the evaluation of noticeable oral malodor using gas chromatography (GC).

METHODS

The oral malodor of 127 adult patients was investigated using the organoleptic test and GC, and the relation between the organoleptic evaluation and VSCs were analyzed.

RESULTS

The optimum cut-off values of CH3SH, H2S and total VSC (CH3SH + H2S) to discriminate between the patients with and without noticeable oral malodor were obtained from ROC curves, and determined to be 0.44, 1.10 and 2.20 ng/10 ml, respectively. The logistic regression was analyzed for estimation of the association between an organoleptic evaluation greater than a slight level and the groups with CH3SH, H2S or total VSC with concentrations above the optimum cut-off value. Only CH3SH showed an independent association with noticeable oral malodor.

CONCLUSIONS

It was evident that CH3SH was a more useful marker for the evaluation of oral malodor than H2S. Moreover, it appears CH3SH is the predominant causative factor of noticeable oral malodor.

The control of ciliary beat frequency

Ciliary movement is powered by axonemal dynein. This article considers how a signal transduction cascade initiated at the cell membrane may activate outer dynein arms to change the velocity of microtubule sliding and the swimming speed of ciliated cells. For Paramecium, a critical event in the cascade is the cAMP-dependent phosphorylation of a 29 kDa polypeptide that is associated with the outer dynein arm.

Re-evaluation and reconstruction of water purification system using soil. I. Assessment of soil as a sorbent of humic substances and phosphate ion

The purpose of our study is to develop a treatment procedure for humic substances (HS hereafter) and phosphate ion in wastewater and environmental water by percolation of the water through a constructed soil layer at the hydraulic loading of a few metres per day. In the present work, batch sorption tests were conducted for more than 80 samples of soil, sludge, mineral and organic materials in order to find good sorbents for fulvic acid (FA hereafter) and phosphate ion. The results showed that the sorption of FA was high for some charcoal, and apatite and goethite minerals. Comparatively high sorption of FA was found for some Andosols and volcanic ash soil. Significant sorption of phosphate ion, on the other hand, was found for various types of soil, sludge from water treatment plants and some waste materials. The linear isotherm was obtained for the sorption of FA to a charcoal, apatite and goethite minerals, and Andosols.

Relationship of physical fitness to chewing in an 80-year-old population

OBJECTIVE

Although tooth loss causes a decrease in masticatory ability, which may influence nutritional status, and impair an individual's general health including physical activity, little is known whether a decrease in chewing ability could result in deterioration in physical fitness in a very elderly population. Thus, the present study evaluated the relationship of chewing ability or teeth number with measures of physical fitness in a sample of 80-years-old in Japan.

DESIGN

Cross-sectional survey.

SUBJECTS AND METHODS

A total of 1282 people who were 80-years old and resided in the Fukuoka Prefecture were approached. A total of 697 individuals (277 male, 420 female) agreed to participate.

RESULTS

Chewing food number and teeth number were related positively with physical fitness measurements of hand grip strength, leg extensor strength, leg extensor power, stepping rate, and one-leg standing time. However, the significant relationship between the number of teeth and physical ability disappeared after adjustment for various confounders, using multiple regression analysis or logistic regression analysis. On the other hand, the relationship of chewing ability with physical fitness measurements of leg extensor strength, one-leg standing time, or isokinetic leg extensor power remained significant even after adjustment for these confounders.

CONCLUSION

There is a relationship between perceived chewing ability (number of foods considered chewable) and physical fitness in this 80-year-old population. Chewing ability may be an independent predictor of physical fitness, thus preventative dental care aimed at preserving chewing ability may be able to enhance activities of daily life and quality of life in very elderly individuals.

Re-evaluation and re-construction of water purification system using soil. II. Removal of pollutants from infiltrating water

Presented in this paper are the results of a series of column experiments and a pilot scale test conducted to develop the treatment system of freshwater and wastewater by their percolation through soil and the other materials at the rate of a few metres per day. Materials that had high ability to sorb fulvic acid (FA hereafter) and phosphate ion were selected based on the results of the batch sorption tests and were processed into beads before subjecting them to the column test. The results of the column experiment suggested that the reagents added to increase the strength of the beads reduced the sorption of FA, thus causing the early breakthrough of the FA injected into the column. Less effect from the bead processing was observed for the removal of phosphate ion. Pilot scale test showed that the removal of particulate fraction of phosphorus differed among the materials used. The bead processing technique that can ensure the high water permeability while maintaining the sorption capacity of the material was required for further development of the treatment system.

Significance of vitamin D receptor gene polymorphism for risk and disease severity of prostate cancer and benign prostatic hyperplasia in Japanese

OBJECTIVE

Recent studies have demonstrated an association between vitamin D receptor (VDR) genotype and prostate cancer. Currently, there is a scarcity of data regarding the association of VDR genotype with benign prostatic hyperplasia (BPH). The purpose of this study was to investigate the TaqI VDR polymorphism in Japanese prostate cancer patients, Japanese BPH patients and Japanese controls in order to determine if an association exists between VDR genotype and the risk of developing prostate cancer and BPH as well as disease severity.

METHODS

110 prostate cancer patients, 83 BPH patients and 90 male age-matched controls were genotyped for a previously described TaqI restriction fragment length polymorphism at codon 352 in exon 9 of the VDR gene. Products were digested into T allele or t allele according to the absence or presence of a TaqI restriction site with individuals being classified as TT, Tt or tt.

RESULTS

The frequency of the genotype tt was higher in the control group (6.7%) compared to patients with prostate cancer (1.8%) and BPH (3.6%) but this was not statistically significant. However, the frequency of the genotype TT was significantly higher among prostate cancer patients with locally advanced or metastatic disease (T3/ T4/N1/M1) compared to controls (p = 0.001). In addition, the genotype TT was significantly higher among prostate cancer patients with a high Gleason grade of tumor (grade 5) compared to controls (p = 0.0001). In addition, the genotype TT was statistically higher in BPH patients with high prostate volume (volume >50 cm(3)) compared to controls (p = 0.001).

CONCLUSION

These data demonstrate that VDR genotype plays an important role in determining the risk of more advanced and aggressive prostate cancer as well as prostatic enlargement in Japanese men.

Temporal sequence of response to unilateral GPi pallidotomy of motor symptoms in Parkinson's disease

The present study was performed to determine the temporal sequence of the response to unilateral MRI/microelectrode-guided pallidotomy of each cardinal symptom in Parkinson's disease (PD). For this purpose, we performed a quantitative assessment of motor functions in 19 patients with PD at several time points up to 6 months following surgery. We here report that although all the motor signs were significantly improved 6 months after pallidotomy, the temporal sequence of tremor response was different from those of other symptoms.

Association of body mass index with blood pressure in 80-year-old subjects

OBJECTIVE

Little data are available on the association between obesity and high blood pressure in elderly individuals, particularly in subjects over 80 years of age. The aim of the present study was to determine the association between body mass index (BMI) and blood pressure in 80-year-old subjects.

METHODS

This study was part of the 8020 Data Bank Survey, which was designed to collect the baseline data of systemic and dental health conditions in 80-year-old subjects. We studied the cross-sectional association of BMI with blood pressures in 645 Japanese (258 men and 387 women), who were 80 years old.

RESULTS

Mean systolic blood pressure rose from 146.6 mmHg in the first quintile of BMI to 147.5 mmHg in the second, 150.3 mmHg in the third, 151.6 mmHg in the fourth, and 156.4 mmHg in the fifth quintiles (test for trend, P = 0.006). Mean diastolic blood pressure rose from 75.8 mmHg in the lowest quintile of BMI to 81.8 mmHg in the highest (test for trend, P = 0.002). We performed multiple regression analysis, controlling for factors known to influence blood pressure values, such as sex, alcohol intake, current smoking status and serum glucose, total cholesterol and creatinine concentrations. The association between BMI and systolic and diastolic blood pressure, respectively, was highly statistically significant in all analyses.

CONCLUSION

These results show that a close relationship is present between obesity and high blood pressure, even in very old subjects.

Clinical and pathological significance of vitamin D receptor gene polymorphism for prostate cancer which is associated with a higher mortality in Japanese

The purpose of this study was to investigate the TaqI vitamin D receptor (VDR) polymorphism in both Japanese prostate cancer patients and Japanese noncancer controls in order to determine if an association exists between VDR genotype with clinical and pathological risk of prostate cancer patients. This study involved 115 patients with prostate cancer and 133 male age-matched noncancer controls genotyped for a previously described TaqI restriction fragment length polymorphism (RFLP) at codon 352 in exon 9 of the VDR gene. Products were digested into T allele or t allele according to the absence or presence of TaqI restriction site with individuals being classified as TT, Tt, or tt. The genotype tt was higher among the control group (6.0%) compared to the patients with prostate cancer (1.8%), but not so (OR=0.28; 95%o CI, 0.06-1.33; p=0.081). In addition, the genotype TT was statistically higher among patients with locally advanced or metastatic disease (T3/T4/NI/M1) compared to controls (OR=2.52; 95%o CI, 1.21-5.27; p=0.009). Lastly, the genotype TT was statistically higher among patients with poorly differentiated adenocarcinoma compared to controls (OR=5.38; 95%o CI, 1.57-18.50; p=0.002). These data demonstrate that VDR genotype plays an important role in determining the risk of more clinically advanced and pathologically aggressive prostate cancer which is associated with a higher mortality rate in Japanese men.

Diagnosis of retrovesical ectopic and hyperplastic prostate tissue by transrectal needle biopsy

We report on an ectopic prostate in a 50-year-old man. Transabdominal ultrasonography, pelvic computed tomography, and pelvic magnetic resonance imaging revealed a heterogeneous tumor 8 cm in diameter in contact with the posterior wall of the urinary bladder. The tumor was histologically confirmed to be a benign prostatic hyperplasia. This is the 3rd case of retrovesical ectopic prostatic tissue which was diagnosed by transrectal needle biopsy.

Abolition of postapoplectic hemichorea by Vo-complex thalamotomy: long-term follow-up study

We report a patient with hemichorea following subthalamic hemorrhage. Vo-complex thalamotomy abolished the choreic movements for over 4 years of follow-up.

Bilateral pallidal stimulation for idiopathic segmental axial dystonia advanced from Meige syndrome refractory to bilateral thalamotomy

Meige syndrome is an adult-onset dystonic movement disorder that predominantly involves facial muscles, while some patients with this syndrome develop spasmodic dysphonia and dystonia of the neck, trunk, arms, and legs. We report that all dystonic symptoms that had been refractory to both pharmacotherapy and bilateral thalamotomy were markedly alleviated by bilateral pallidal stimulation in a patient with segmental axial dystonia advanced from Meige syndrome.

[A case of permanent pacemaker implantation in small infant using steroid-eluting epicardial pacing lead: changes of the pacing threshold in acute phase]

A 1-year-old infant with complete atrioventricular block was successfully treated with the pacemaker implantation using steroid-eluting epicardial pacing lead by the subxyphoid approach. Pacing threshold after implantation were measured frequently to use the function named "Capture management" of the generator (Medtronic: Kappa, Model 701). The postoperative pacing threshold were kept lower and stabilized after 5 weeks.

Relationship between tooth loss and electrocardiographic abnormalities in octogenarians

Recent reports have suggested that periodontal disease is a risk factor for coronary heart disease (CHD). However, little is known about the relationship between periodontal disease and CHD in the very elderly. Therefore, we evaluated the association between tooth loss and abnormal ECG findings in octogenarians. Of the 1,282 octogenarians in Fukuoka Prefecture, Japan, 697 participated. Oral examinations--including a tooth count and an assessment of the Community Periodontal Index--and a 12-lead ECG were performed. Logistic regression analysis revealed that individuals with < 20 teeth had increased prevalence of ST segment depression, and T-wave abnormalities, after we adjusted for gender, smoking, serum cholesterol and glucose, blood pressure, and body mass index. Compared with individuals with > or = 20 teeth, edentulous individuals had an increased prevalence of T-wave abnormalities and arrhythmias after adjustment for coronary risk factors. We conclude that tooth loss may be an independent predictor of abnormal ECG findings in octogenarians.

A role of netrin-1 in the formation of the subcortical structure striatum: repulsive action on the migration of late-born striatal neurons

The mammalian striatum arises in the basal telencephalon and contains morphologically homogenous neurons that can be divided into two distinct compartments, patches and the matrix. During development, patch neurons are generated first to form a striatal primordium. After a large influx of later-born matrix neurons into this region, the unique mosaic arrangement of these two neuronal phenotypes is established. The massive migration of matrix neurons continues during the embryonic period, and they eventually comprise 80-85% of the mature striatum. To elucidate the cellular mechanism or mechanisms underlying this critical event in striatal histogenesis, we examined the migration characteristics of striatal subventricular zone (SVZ) cells at embryonic day 18 when neurogenesis peaks for matrix neurons. Using gel cultures, we show that netrin-1, one of the diffusible guidance cues expressed in the striatal ventricular zone (VZ), exerts a repulsive action on migrating SVZ cells. This effect is blocked in the presence of antibodies against Deleted in colorectal cancer (DCC), a putative receptor for netrin-1. The expression patterns of netrin-1 and DCC strongly suggest the involvement of this effect in the outward migration of SVZ cells into the striatal postmitotic region. Our cell tracing study using living brain slices demonstrates that striatal SVZ cells migrate toward and disperse throughout the striatum, in which they differentiate into phenotypes of striatal projection neurons. We suggest that netrin-1 expressed in the striatal VZ serves to guide the large influx of striatal matrix neurons into the striatal primordium and is thereby involved in the initial formation of fundamental striatal structures.

A regulatory light chain of ciliary outer arm dynein in Tetrahymena thermophila

Ciliary beat frequency is primarily regulated by outer arm dyneins (22 S dynein). Chilcote and Johnson (Chilcote, T. J., and Johnson, K. A. (1990) J. Biol. Chem. 256, 17257-17266) previously studied isolated Tetrahymena 22 S dynein, identifying a protein p34, which showed cAMP-dependent phosphorylation. Here, we characterize the molecular biochemistry of p34 further, demonstrating that it is the functional ortholog of the 22 S dynein regulatory light chain, p29, in Paramecium. p34, thiophosphorylated in isolated axonemes in the presence of cAMP, co-purified with 22 S dynein and not with inner arm dynein (14 S dynein). Isolated 22 S dynein containing phosphorylated p34 showed approximately 70% increase in in vitro microtubule translocation velocity compared with its unphosphorylated counterpart. Extracted p34 rebound to isolated 22 S dynein from either Tetrahymena or Paramecium but not to 14 S dynein from either ciliate. Binding of radiolabeled p34 to 22 S dynein was competitive with p29. Phosphorylated p34 was not present in axonemes isolated from a mutant lacking outer arms. Two-dimensional gel electrophoresis followed by phosphorimaging revealed at least five phosphorylated p34-related spots, consistent with multiple phosphorylation sites in p34 or perhaps multiple isoforms of p34. These new features suggest that a class of outer arm dynein light chains including p34 regulates microtubule sliding velocity and consequently ciliary beat frequency through phosphorylation.

Absence of aflatoxin biosynthesis in koji mold (Aspergillus sojae)

Ten strains isolated from industrial soy sauce producing koji mold were identified as Aspergillus sojae and distinguished from Aspergillus parasiticus morphologically and physiologically. There was no detectable aflatoxin in any culture extracts of A. sojae strains. Strain 477 was chosen as a representative strain of industrial A. sojae for further molecular analysis. All enzymatic activities associated with the aflatoxin biosynthesis were not detected or negligible in strain 477 compared with that of the A. parasiticus strain. Southern analysis suggested that the genomic DNA of strain 477 contained aflatoxin biosynthetic pathway genes. In contrast, all industrial strains lacked detectable transcripts of aflR, the main regulatory gene for aflatoxin biosynthesis, under the aflatoxin-inducing condition. Our data suggest that defects in aflR expression cause the lack of expression of aflatoxin-related genes which results in the absence of aflatoxin biosynthesis in A. sojae strains.

Free medial plantar perforator flaps for the resurfacing of finger and foot defects

In this article, three cases in which free medial plantar perforator flaps were successfully transferred for coverage of soft-tissue defects in the fingers and foot are described. This perforator flap has no fascial component and is nourished only by perforators of the medial plantar vessel and a cutaneous vein or with a small segment of the medial plantar vessel. The advantages of this flap are minimal donor-site morbidity, minimal damage to both the posterior tibial and medial plantar systems, no need for deep dissection, the ability to thin the flap by primary removal of excess fatty tissue, the use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, short time for flap elevation, possible application as a flow-through flap, and a concealed donor scar.

Early-generated preplate neurons in the developing telencephalon: inward migration into the developing striatum

Specialized subsets of early-generated neurons provide the cellular cues that are necessary for the establishment of characteristic cell and fiber interactions in each brain region. During the development of the mammalian cerebral cortex, the early-generated cells line up in the most superficial part of the telencephalic pallium forming the preplate. It has been generally thought that the preplate derivatives are exclusively located in the cortical region and govern the early histogenetic phase of cortical development. However, we here disclose an unexpected evidence that a subset of early-generated neurons of the piriform preplate migrate inward into and disperse within the subcortical structure striatum during the embryonic stage. Their migratory route is unique and its direction is opposite to the ordinary migration of neuronal precursors directed outward from the periventricular germinal zone. After immigrating into the developing striatum, these early-generated cells are closely associated with the intrastriatal fascicules of axons. The majority of these cells are eliminated by apoptotic cell death during the early postnatal stage. Based on these findings, we propose a new concept: the preplate neurons may not only direct cortical histogenesis but also change their location to play a role in the development of subcortical structures.

[Usefulness of power Doppler ultrasound in a patient with renal cell carcinoma in the wall of a simple renal cyst]

We present a case of renal cell carcinoma in the wall of a simple renal cyst. A 54-year-old man visited our hospital with a complaint of right back pain. Ultrasound study revealed right hydronephrosis, a ureteral stone, and a 9 x 8 cm renal cyst, with a tumor, 2 cm in diameter, in the cyst wall. Power Doppler Ultrasound and enhanced computed tomography demonstrated hypervascularity of the tumor. Clinically, he was diagnosed as renal cell carcinoma and nephrectomy was performed. Pathological findings of the tumor showed clear cell carcinoma in the wall of a simple renal cyst. Twelve months after the nephrectomy, he was free from recurrence.