OBJECTIVE

To assess whether frailty in acutely admitted older medical patients, assessed by a self-report questionnaire and evaluation of functional level at discharge, was associated with readmission or death within 6 months after discharge. A second objective was to assess the predictive performance of models including frailty, functional level, and known risk factors.

METHODS

A cohort study including acutely admitted older patients 65+ from seven medical and two acute medical units. The Tilburg Frailty Indicator (TFI), Timed-Up-and-Go (TUG), and grip strength (GS) exposure variables were measured. Associations were assessed using Cox regression with first unplanned readmission or death (all-causes) as the outcome. Prediction models including the three exposure variables and known risk factors were modelled using logistic regression and C-statistics.

RESULTS

Of 1328 included patients, 50% were readmitted or died within 6 months. When adjusted for gender and age, there was an 88% higher risk of readmission or death if the TFI scores were 8-13 points compared to 0-1 points (HR 1.88, CI 1.38;2.58). Likewise, higher TUG and lower GS scores were associated with higher risk of readmission or death. The area under the curve for the prediction models ranged from 0.64 (0.60;0.68) to 0.72 (0.68;0.76).

CONCLUSIONS

In acutely admitted older medical patients, higher frailty assessed by TFI, TUG, and GS was associated with a higher risk of readmission or death within 6 months after discharge. The performance of the prediction models was mediocre, and the models cannot stand alone as risk stratification tools in clinical practice.

BACKGROUND

To assess the internal consistency reliability and construct validity of the Dutch version of the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD).

METHODS

The psychometric properties of the Dutch WHOQOL-OLD were examined in a cross-sectional study using a sample of 1,340 people aged 60 years or older. Participants completed a Web-based questionnaire, the 'Senioren Barometer'. Reliability was evaluated using Cronbach's alpha and corrected item-total correlations. Construct validity of the Dutch WHOQOL-OLD was evaluated with confirmatory factor analyses, and correlations within and between scales, using scales WHOQOL-BREF, Short Form Health Survey (SF-12), Tilburg Frailty Indicator (TFI), and the Emotional and Social Loneliness Scale (ESLS).

RESULTS

The reliabilities of the six WHOQOL-OLD facets or subscales were sufficient to good (.66-.91). The convergent validity of the WHOQOL-OLD was good, whereas our findings on the divergent validity of the WHOQOL-OLD were somewhat mixed. Findings corroborating the divergent validity were that the 6-factor model fitted better than the second-order factor model, and WHOQOL-OLD facets sensory abilities, past, present and future activities, death and dying, intimacy correlated more strongly with similar than dissimilar scales. Not fully supporting divergent validity were the extremely high correlations between the factors corresponding to autonomy, past, present and future activities, and social participation.

CONCLUSIONS

We offer Dutch healthcare and social workers an instrument with good psychometric properties for measuring quality of life in older people. Further research on interrelations between WHOQOL-OLD facets is recommended.

The introduction of CDK4/6 inhibitors in combination with endocrine therapy (ET) represents the most relevant advance in the management of hormone receptor (HR) positive, HER2-negative metastatic breast cancer over the last few years. This meta-analysis of randomized controlled trials (RCTs) is aimed to better characterize the efficacy of CDK4/6 inhibitors in some relevant subgroups and to test heterogeneity between different compounds with a particular focus on their ability to improve overall survival (OS). Pooled estimates of hazard ratios (HRs) were computed for progression-free survival (PFS), OS, and objective response rate (ORR) analysis in predefined subgroups to better understand treatment effect concerning specific patients' characteristics. To estimate the absolute benefit in terms of PFS, pooled survival curves were generated by pooling the data of all trials. A total of eight RCTs were included. Adding a CDK4/6 inhibitor to ET is beneficial in terms of PFS, irrespective of the presence or not of visceral metastases, the number of metastatic sites, and the length of the treatment-free interval (TFI). The addition of CDK4/6 inhibitors produces a significant OS improvement, both in aromatase inhibitor (AI)-sensitive (HR 0.75, 95% CI) and AI-resistant patients (HR 0.77, 95% CI [0.67-0.89]). Pooled data from each single drug show that palbociclib remains the only class member not showing a statistically significant HR for OS (HR 0.83, 95% CI [0.68-1.02]).

Keywords: CDK4/6 inhibitors; cancer; epidemiology; hormone receptors; hormone therapy; metastatic breast cancer; overall survival; subgroup analysis; therapies.

OBJECTIVE

Urine colour (U Col) is simple to measure, differs between low-volume and high-volume drinkers, and is responsive to changes in daily total fluid intake (TFI). However, to date, no study has quantified the relationship between a change in TFI and the resultant change in U Col. This analysis aimed to determine the change in TFI needed to adjust 24-h U Col by 2 shades on an 8-colour scale, and to evaluate whether starting U Col altered the relationship between the change in TFI and change in U Col.

METHODS

We performed a pooled analysis on data from 238 healthy American and European adults (50 % male; age, 28 (sd 6) years; BMI 22.9 (sd 2.6) kg/m(2)), and evaluated the change in TFI, urine volume (U Vol), and specific gravity (U SG) associated with a change in U Col of 2 shades.

RESULTS

The mean [95 % CI] change in TFI and U Vol associated with a decrease in U Col by 2 shades (lighter) was 1110 [914;1306] and 1011 [851;1172] mL/day, respectively, while increasing U Col by 2 shades (darker) required a reduction in TFI and U Vol of -1114 [-885;-1343] and -977 [-787;-1166] mL/day. The change in U Col was accompanied by changes in U SG (lighter urine: -.008 [-.007;-.010]; darker urine: +.008 [.006;.009]). Starting U Col did not significantly impact the TFI change required to modify U Col by 2 shades.

CONCLUSIONS

Our results suggest a quantifiable relationship between a change in daily TFI and the resultant change in U Col, providing individuals with a practical means for evaluating and adjusting hydration behaviours.

BACKGROUND

Improving bonding strength to fluorosed teeh.

OBJECTIVE

To determine the effect of deproteinization using 5.25% sodium hypochlorite (NaOCl) prior to acid etching on shear bond strength of orthodontic brackets bonded to fluorosed teeth.

METHODS

In vitro experimental study.

METHODS

Forty freshly extracted human mandibular first premolars with TFI 4 were selected and divided into two groups of 20 each. In Group I the teeth were acid etched with 37% phosphoric acid and bonded with composite. In Group II the teeth were deproteinized with 5.25% NaOCl prior to acid etching with 37% phosphoric acid and were bonded with composite. Samples were then subjected to shear bond test by Instron Universal Testing machine. The sample from each group were selected for the SEM study (prior to bonding) to analyze the etching patterns achieved.

METHODS

Data was checked for normality by Shapiro Wilk Test, to compare the two groups unpaired t test was used. P value was predetermined at ≤ 0.05.

RESULTS

The S BS of Group II (11.75 ± 2.83 MPa) was higher than Group I (7.44 ± 2.43 MPa) and the difference was statistically significant (P = 0.000). On SEM the etching pattern was more of type 1 and 2 in Group II.

CONCLUSIONS

Deproteinization using 5.25% NaOCl prior to acid etching significantly increases the shear bond strength of brackets bonded to fluorosed teeth and can be used as a convenient and effective option in orthodontic bonding to fluorosed teeth.

There is established association between oxidative stress, infections of genital tract and fertility. Genital tract infections may provoke increased production of free radicals and generate oxidative stress that can be involved in pathophysiology of a number of reproductive diseases and complications during pregnancy. The aim of this study was to determine connection between oxidative stress and infertility associated with persistent chlamydial infection. Serum samples of infertile women with tubal factor infertility (TFI), women with multiple spontaneous abortions (MSA) and fertile women was screened for C. trachomatis MOMP specific IgG and IgA antibodies and cHSP60 specific igG antibodies using ELISA. The levels of superoxide anion radical, nitric oxide and reduced glutathione were determined spectrophotometricaly. Serum levels of testosterone, luteinizing hormone and follicle stimulating hormone were determined by enzyme-linked fluorescent immunoassay method. Our results showed that persistent infection was more prevalent in TFI than in MSA group, whereas seropositivity was higher in MSA than in TFI group of patients. We also found that superoxide anion was significantly lower, while LH was markedly higher in TFI and MSA group of patients. However, when our results were analyzed according to the serological status of chlamydial infection, we found that parameters of oxidative stress, superoxide anion and index of oxidative stress, defined as relative ratio between superoxide anion and nitrites sum and glutathione ((O2-+NO2-)/GSH) were significantly elevated in infertile patients with persistent chlamydial infection compared to seropositive and seronegative patients. Our findings point to the possible impact of Chlamydia trachomatis infection on prooxidative-antioxidative balance that can influence fertility potential in women with persistent chlamydial infection.

Epigenetic inheritance was transmitted through selection over five generations of extreme early, but not late flowering time phenotypic lines in Fragaria vesca. Epigenetic variation was initially artificially induced using the DNA demethylation reagent 5-azacytidine (5-azaC). It is the first report to explore epigenetic variant selection and phenotypic trait inheritance in strawberry. Transmission frequency of these traits was determined across generations. The early flowering (EF4) and late stolon (LS) phenotypic traits were successfully transmitted across five and three generations through meiosis, respectively. Stable mitotic transmission of the early flowering phenotype was also demonstrated using clonal daughters derived from the 4th Generation (S4) mother plant. In order to further explore the DNA methylation patterns underlying the early flowering trait, the standard MSAP method using isoschizomers Hpa II/Msp I, and newly modified MSAP method using isoschizomers Tfi I/Pfe I which detected DNA methylation at CG, CHG, CHH sites were used in two early flowering lines, EF lines 1 (P2) and EF lines 2 (P3), and control lines (P1). A significant reduction in the number of fully-methylated bands was detected in P2 and P3 when compared to P1 using the novel MSAP method. In the standard MSAP, the symmetric CG and CHG methylation was maintained over generations in the early flowering lines based on the clustering in P2 and P3, the novel MSAP approach revealed the asymmetric CHH methylation pattern was not maintained over generations. This study provides evidence of stable selection of phenotypic traits, particularly early flowering through both meiosis and mitosis, which is meaningful to both breeding programs and commercial horticulture. The maintenance in CG and CHG methylation over generations suggests the early flowering phenotype might be related to DNA methylation alterations at the CG or CHG sites. Finally, this work provides a new approach for studying the role of epigenetics on complex quantitative trait improvement in strawberry, as well as providing a tool to expand phenotypic diversity and expedite potential new horticulture cultivar releases through either seed or vegetative propagation.

OBJECTIVE

Assess the impact of a reduction of tinnitus intensity achieved through sound stimulation during sleep on the improvement in the patients' quality of life.

METHODS

Acoustic stimuli consisted of a highly customized sound that reproduced the spectral and intensity characteristics of the tinnitus in each patient. This stimulus was uploaded into a portable electronic device and delivered through customized ear buds during sleep, every night for three months.

METHODS

Twelve patients with subjective idiopathic chronic tinnitus were studied.

RESULTS

Results were assessed through: (1) the measurement in dB SPL of tinnitus intensity reduction over time; (2) the results of three psychometric tests: Tinnitus handicap inventory (THI), Tinnitus reaction questionnaire (TRQ), Tinnitus functional index (TFI); and (3) a Visual analog scale (VAS) for tinnitus annoyance. After three months of treatment, we observed an average decrease in tinnitus intensity of 14.1 dB SPL (p < 0.001), implying a 62% reduction of the perceived sound. This improvement was followed by a statistically significant decrease of TRQ (78%), THI (65%), and TFI (77%).

CONCLUSIONS

These results suggested that the intensity reduction achieved through the protocol used in this study had a direct impact on the improvement in the patients' quality of life.

In human telencephalon at 8-12 postconceptional weeks, ribonucleic acid quantitative sequencing and immunohistochemistry revealed cortical chicken ovalbumin upstream promotor-transcription factor 1 (COUP-TFI) expression in a high ventro-posterior to low anterior gradient except for raised immunoreactivity in the anterior ventral pallium. Unlike in mouse, COUP-TFI and SP8 were extensively co-expressed in dorsal sensory neocortex and dorsal hippocampus whereas COUPTFI/COUPTFII co-expression defined ventral temporal cortex and ventral hippocampus. In the ganglionic eminences (GEs) COUP-TFI immunoreactivity demarcated the proliferative zones of caudal GE (CGE), dorsal medial GE (MGE), MGE/lateral GE (LGE) boundary, and ventral LGE whereas COUP-TFII was limited to ventral CGE and the MGE/LGE boundary. Co-labeling with gamma amino butyric acidergic interneuron markers revealed that COUP-TFI was expressed in subpopulations of either MGE-derived (SOX6+) or CGE-derived (calretinin+/SP8+) interneurons. COUP-TFII was mainly confined to CGE-derived interneurons. Twice as many GAD67+ cortical cells co-labeled for COUP-TFI than for COUP-TFII. A fifth of COUP-TFI cells also co-expressed COUP-TFII, and cells expressing either transcription factor followed posterior or anterio-lateral pathways into the cortex, therefore, a segregation of migration pathways according to COUP-TF expression as proposed in mouse was not observed. In cultures differentiated from isolated human cortical progenitors, many cells expressed either COUP-TF and 30% also co-expressed GABA, however no cells expressed NKX2.1. This suggests interneurons could be generated intracortically from progenitors expressing either COUP-TF.

Transient brain ischemia triggers selective neuronal death/loss, especially in vulnerable regions of the brain including the hippocampus. Laminarin, a polysaccharide originating from brown seaweed, has various pharmaceutical properties including an antioxidant function. To the best of our knowledge, few studies have been conducted on the protective effects of laminarin against ischemic injury induced by ischemic insults. In this study, we histopathologically investigated the neuroprotective effects of laminarin in the Cornu Ammonis 1 (CA1) field of the hippocampus, which is very vulnerable to ischemia-reperfusion injury, following transient forebrain ischemia (TFI) for five minutes in gerbils. The neuroprotective effect was examined by cresyl violet staining, Fluoro-Jade B histofluorescence staining and immunohistochemistry for neuronal-specific nuclear protein. Additionally, to study gliosis (glial changes), we performed immunohistochemistry for glial fibrillary acidic protein to examine astrocytes, and ionized calcium-binding adaptor molecule 1 to examine microglia. Furthermore, we examined alterations in pro-inflammatory M1 microglia by using double immunofluorescence. Pretreatment with 10 mg/kg laminarin failed to protect neurons in the hippocampal CA1 field and did not attenuate reactive gliosis in the field following TFI. In contrast, pretreatment with 50 or 100 mg/kg laminarin protected neurons, attenuated reactive gliosis and reduced pro-inflammatory M1 microglia in the CA1 field following TFI. Based on these results, we firmly propose that 50 mg/kg laminarin can be strategically applied to develop a preventative against injuries following cerebral ischemic insults.

OBJECTIVE

To report daily total fluid intake (TFI) and fluid types in Indonesia according to age, sex, socio-economic status (SES) and geographic region, and compare TFI with the Indonesian adequate fluid intake (AI) recommendations.

METHODS

Data were collected in 32 cities over nine regions from children (4-9 years, n = 388), adolescents, (10-17 years, n = 478) and adults (18-65 years, n = 2778) using a fluid intake 7-day record (Liq.In7); socio-economic status was also recorded. The 7-day mean TFIs were compared with the AI of water set by the Ministry of Health of the Republic of Indonesia.

RESULTS

Total median fluid intakes for all age groups exceeded 2000 mL/day. At population level, TFI was associated with household income (P < 0.001), education (P < 0.001) and Indonesian geographical regions (P < 0.001). More than 67% of participants met the AI of water from fluids. A higher percentage of children and adolescents met the AI (78 and 80%, respectively), compared with adults (72%). Drinking water was the main contributor to TFI in all age groups (76-81%). Sugar-sweetened beverages (SSB) were consumed by 62% children, 72% adolescents and 61% of adults. An SSB intake ≥ 1 serving per day was observed for 24% children, 41% adolescents and 33% adults.

CONCLUSIONS

A high percentage of the population drank enough to meet the AI of water from fluids. Water was the most frequently consumed drink; however, many participants consumed at least one serving of SSB per day. This study provides data to help direct targeted intervention programs.

Rheumatoid arthritis (RA) has a large and varied impact on the quality of life as associated with patient health including both physical and mental well-being. The aim of the study was to assess the factors that affect the assessment of the quality of life of RA patients depending on the prevalence of frailty syndrome.

Material and methods: The study involved 106 patients with RA (82 women; mean age 65.83 ± 5.01), who had been hospitalized in the Silesian Centre for Rheumatology, Rehabilitation and Disability Prevention in Ustron, Poland. The patients that were included in the study were divided into two groups depending on the incidence of frailty syndrome: Group 1 - robust patients and Group 2 - patients with frailty syndrome.

Results: Frailty syndrome was identified in 34.9% of the patients with recognized/diagnosed RA; in women, it was 36.14% and in men, it was 25.92%. The average TFI value was 4.11 ± 2.05; in the physical domain, it was 3.39 ± 1.66; in the mental domain, it was 0.41 ± 0.55 and in the social domain, it was 0.31 ± 0.48. The robust patients assessed their quality of life associated with sleep as being worse compared to patients with recognized frailty syndrome.

Conclusion: Frailty syndrome has no significant impact on the assessment of the quality of life of patients with diagnosed RA. The factors that determine quality of life are different in robust patients and in patients with frailty syndrome. The assessment of the quality of life is affected by the degree of an individual's fitness regardless of the occurrence of frailty syndrome.

Keywords: Frailty; Quality of life; Rheumatoid arthritis.

Background: While normal tinnitus is a short-term sensation of limited duration, in 10-15% of the general population it develops into a chronic condition. For 3-6% it seriously interferes with many aspects of life. Objective: The aim of this trial was to assess effectiveness of a trauma-focused approach, eye movement desensitization and reprocessing (EMDR), in reducing tinnitus distress. Methods: The sample consisted of 35 adults with high levels of chronic tinnitus distress from five general hospitals in the Netherlands. Participants served as their own controls. After pre-assessment (T1), participants waited for a period of 3 months, after which they were assessed again (T2) before they received six 90 min manualized EMDR treatment sessions in which tinnitus-related traumatic or stressful events were the focus of treatment. Standardized self-report measures, the Tinnitus Functional Index (TFI), Mini-Tinnitus Questionnaire (Mini-TQ), Symptom Checklist-90 (SCL-90) and the Self-Rating Inventory List for Post-traumatic Stress Disorder (SRIP), were completed again halfway through treatment (T3), post-treatment (T4) and at 3 months' follow-up (T5). Results: Repeated measures analysis of variance revealed significant improvement after EMDR treatment on the primary outcome, TFI. Compared to the waiting-list condition, scores significantly decreased in EMDR treatment [t(34) = -4.25, p < .001, Cohen's dz = .72]. Secondary outcomes, Mini-TQ and SCL-90, also decreased significantly. The treatment effects remained stable at 3 months' follow-up. No adverse events or side effects were noted in this trial. Conclusions: This is the first study to suggest that EMDR is effective in reducing tinnitus distress. Randomized controlled trials are warranted.

Masking is widely used in the management of tinnitus, however, masking at the perceived spatial location of tinnitus has not been investigated. This article examines the development of a method for the spatial masking of tinnitus. This report consists of three studies: Study I is a proof of concept study comparing customized spatial masking to conventional bilateral masking; Study II is a prototype evaluation in which the spatial masking paradigm was compared to a bilaterally equal masker using iPods connected to hearing aids in a 4-week cross-over trial; and Study III is a 4-month crossover pilot study-using prototype hearing aid-based maskers, and in which three-dimensional (3D) masking (2 months) was compared to a Tinnitus Retraining Therapy (2 months). There was a preference for the 3D masking stimulus across all three studies. Individual changes in the Tinnitus Handicap Inventory (THI) after 2 weeks of trial (Study II) and Tinnitus Functional Index (TFI) after 2 months of trial (Study III) were observed without large group differences. The spatial masking concept was piloted successfully. The qualitative and quantitative results obtained indicate directions for future clinical trials and therapy development. This study indicates that spatial masking of tinnitus is feasible, of benefit to many participants, and warrants further trials.

Objectives: A randomized cross-over trial in 18 participants tested the hypothesis that nature sounds, with unpredictable temporal characteristics and high valence would yield greater improvement in tinnitus than constant, emotionally neutral broadband noise. Study Design: The primary outcome measure was the Tinnitus Functional Index (TFI). Secondary measures were: loudness and annoyance ratings, loudness level matches, minimum masking levels, positive and negative emotionality, attention reaction and discrimination time, anxiety, depression and stress. Each sound was administered using MP3 players with earbuds for 8 continuous weeks, with a 3 week wash-out period before crossing over to the other treatment sound. Measurements were undertaken for each arm at sound fitting, 4 and 8 weeks after administration. Qualitative interviews were conducted at each of these appointments. Results: From a baseline TFI score of 41.3, sound therapy resulted in TFI scores at 8 weeks of 35.6; broadband noise resulted in significantly greater reduction (8.2 points) after 8 weeks of sound therapy use than nature sounds (3.2 points). The positive effect of sound on tinnitus was supported by secondary outcome measures of tinnitus, emotion, attention, and psychological state, but not interviews. Tinnitus loudness level match was higher for BBN at 8 weeks; while there was little change in loudness level matches for nature sounds. There was no change in minimum masking levels following sound therapy administration. Self-reported preference for one sound over another did not correlate with changes in tinnitus. Conclusions: Modeled under an adaptation level theory framework of tinnitus perception, the results indicate that the introduction of broadband noise shifts internal adaptation level weighting away from the tinnitus signal, reducing tinnitus magnitude. Nature sounds may modify the affective components of tinnitus via a secondary, residual pathway, but this appears to be less important for sound effectiveness. The different rates of adaptation to broadband noise and nature sound by the auditory system may explain the different tinnitus loudness level matches. In addition to group effects there also appears to be a great deal of individual variation. A sound therapy framework based on adaptation level theory is proposed that accounts for individual variation in preference and response to sound. Clinical Trial Registration: www.anzctr.org.au, identifier #12616000742471.

Masking has been widely used as a tinnitus therapy, with large individual differences in its effectiveness. The basis of this variation is unknown. We examined individual tinnitus and psychological responses to three masking types, energetic masking (bilateral broadband static or rain noise [BBN]), informational masking (BBN with a notch at tinnitus pitch and 3-dimensional cues) and a masker combining both effects (BBN with spatial cues). Eleven participants with chronic tinnitus were followed for 12 months, each person used each masking approach for 3 months with a 1 month washout-baseline. The Tinnitus Functional Index (TFI), Tinnitus Rating Scales, Positive and Negative Affect Scale and Depression Anxiety Stress Scales, were measured every month of treatment. Electroencephalography (EEG) and psychoacoustic assessment was undertaken at baseline and following 3 months of each masking sound. The computational modeling of EEG data was based on the framework of brain-inspired Spiking Neural Network (SNN) architecture called NeuCube, designed for this study for mapping, learning, visualizing and classifying of brain activity patterns. EEG was related to clinically significant change in the TFI using the SNN model. The SNN framework was able to predict sound therapy responders (93% accuracy) from non-responders (100% accuracy) using baseline EEG recordings. The combination of energetic and informational masking was an effective treatment sound in more individuals than the other sounds used. Although the findings are promising, they are preliminary and require confirmation in independent and larger samples.

Keywords: Electroencephalography; Masking; Spiking Neural Network; Therapy; Tinnitus.

OBJECTIVE

The purpose of this study was to evaluate the impact of caries and fluorosis on oral health-related quality of life (OHRQoL) among schoolchildren living in areas with high concentrations of fluoride in water.

METHODS

Five hundred and twenty-four schoolchildren (8-12 year olds) residing in rural communities in central Mexico were examined for oral hygiene, caries (International Caries Detection and Assessment System, ICDAS II), and fluorosis (Thylstrup and Fejerskov Index, TFI). OHRQoL was evaluated with the Child Perceptions Questionnaire for two age groups (CPQ8-10 and CPQ11-14). Generalized structural equation models were constructed for data analysis.

RESULTS

Overall prevalence of caries was 88.5% and fluorosis 46.9%. In the group of 8-10 year olds, 48% of the children had advanced carious lesions in primary or permanent teeth (ICDAS ≥4), 22.6% had moderate/severe fluorosis, and 59.9% of children had an impact on OHRQoL. Schoolchildren with ICDAS ≥4 were more likely [OR = 1.75, (95% CI 1.34-2.28)] to suffer a negative impact on OHRQoL. In the group of 11-12 year olds, 19.9% of children had advanced carious lesions and 23.2% showed moderate/severe fluorosis; 67.3% of children reported had an impact on OHRQoL. Children 11-12 year olds with fluorosis (TFI ≥4) [OR = 2.39 (95% CI 2.12-2.69)], caries (ICDAS ≥4) [OR = 2.18 (95% CI 2.13-2.24)], and low brushing frequency [OR = 2.04 (95% CI 1.21-3.44)] were more likely to have deterioration on OHRQoL.

CONCLUSIONS

A negative impact on OHRQoL was observed in children with caries and fluorosis.

CONCLUSIONS

Deterioration on OHRQoL found in children as a sequel of caries and fluorosis should be considered when designing health policies leading to prevention and effective health promotion programs and incorporated to clinical guidelines for timely dental treatment.

Background: Patients with advanced high-grade serous ovarian cancer (HGSOC) are usually treated with paclitaxel and carboplatin; however, predictive markers for this drug combination are unknown.

Methods: Tumor samples from 71 consecutive HGSOC patients, who received neoadjuvant chemotherapy with paclitaxel and carboplatin, were subjected to molecular analysis.

Results: BRCA1/2 germline mutation carriers (n = 22) had longer treatment-free interval (TFI) than non-carriers (n = 49) (9.5 months vs. 3.8 months; P = 0.007). Fifty-one HGSOCs had sufficient quality of tumor DNA for the next-generation sequencing (NGS) analysis by the SeqCap EZ CNV/LOH Backbone Design panel. All 13 tumors obtained from BRCA1/2 germline mutation carriers and 12 sporadic HGSOCs showed a high number of evenly spread chromosomal breaks, which was defined as a BRCAness phenotype; median TFI for this combined group approached 9.5 months. The remaining 26 HGSOCs had similarly high global LOH score (above 20%); however, in contrast to BRCAness tumors, LOH involved large chromosomal segments; these patients had significantly lower TFI (3.7 months; P = 0.006). All patients with CCNE1 amplification (n = 7), TP53 R175H substitution (n = 6), and RB1 mutation (n = 4) had poor response to paclitaxel plus carboplatin.

Conclusion: This study describes a cost-efficient method of detecting the BRCAness phenotype, which is compatible with the laboratory-scale NGS equipment. Some molecular predictors allow the identification of potential non-responders to paclitaxel plus carboplatin, who may need to be considered for other treatment options.

Keywords: BRCAness; Neoadjuvant chemotherapy; Ovarian cancer; Targeted sequencing; Treatment response.

BACKGROUND

Chlamydia is the most common sexually transmitted bacterial infection in Scotland, and is associated with potentially serious reproductive outcomes, including pelvic inflammatory disease (PID) and tubal factor infertility (TFI) in women. Chlamydia testing in Scotland is currently targeted towards symptomatic individuals, individuals at high risk of existing undetected infection, and young people. The cost-effectiveness of testing and treatment to prevent PID and TFI in Scotland is uncertain.

METHODS

A compartmental deterministic dynamic model of chlamydia infection in 15-24 year olds in Scotland was developed. The model was used to estimate the impact of a change in testing strategy from baseline (16.8% overall testing coverage; 0.4 partners notified and tested/treated per treated positive index) on PID and TFI cases. Cost-effectiveness calculations informed by best-available estimates of the quality-adjusted life years (QALYs) lost due to PID and TFI were also performed.

RESULTS

Increasing overall testing coverage by 50% from baseline to 25.2% is estimated to result in 21% fewer cases in young women each year (PID: 703 fewer; TFI: 88 fewer). A 50% decrease to 8.4% would result in 20% more PID (669 additional) and TFI (84 additional) cases occurring annually. The cost per QALY gained of current testing activities compared to no testing is £40,034, which is above the £20,000-£30,000 cost-effectiveness threshold. However, calculations are hampered by lack of reliable data. Any increase in partner notification from baseline would be cost-effective (incremental cost per QALY gained for a partner notification efficacy of 1 compared to baseline: £5,119), and would increase the cost-effectiveness of current testing strategy compared to no testing, with threshold cost-effectiveness reached at a partner notification efficacy of 1.5. However, there is uncertainty in the extent to which partner notification is currently done, and hence the amount by which it could potentially be increased.

CONCLUSIONS

Current chlamydia testing strategy in Scotland is not cost-effective under the conservative model assumptions applied. However, with better data enabling some of these assumptions to be relaxed, current coverage could be cost-effective. Meanwhile, increasing partner notification efficacy on its own would be a cost-effective way of preventing PID and TFI from current strategy.

Objectives: To compare image noise and sharpness of vessels, liver, and muscle in lower extremity CT angiography between "adaptive statistical iterative reconstruction-V" (ASIR-V) and deep learning reconstruction "TrueFidelity" (TFI).

Methods: Thirty-seven patients (mean age, 65.2 years; 32 men) with lower extremity CT angiography were enrolled between November and December 2019. Images were reconstructed with two ASIR-V (blending factor of 80% and 100% (AV-100)) and three TFI (low-, medium-, and high-strength-level (TF-H) settings). Two radiologists evaluated these images for vessels (aorta, femoral artery, and popliteal artery), liver, and psoas muscle. For quantitative analyses, conventional indicators (CT number, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR)) and blur metric values (indicating the degree of image sharpness) of selected regions of interest were determined. For qualitative analyses, the degrees of quantum mottle and blurring were assessed.

Results: The higher the blending factor in ASIR-V or the strength in TFI, the lower the noise, the higher the SNR and CNR values, and the higher the blur metric values in all structures. The SNR and CNR values of TF-H images were significantly higher than those of AV-80 images and similar to those of AV-100 images. The blur metric values in TFI images were significantly lower than those in ASIR-V images (p < 0.001), indicating increased sharpness. Among all the investigated image procedures, the overall qualitative image quality was best in TF-H images.

Conclusion: TF-H was the most balanced image in terms of image noise and sharpness among the examined image combinations.

Key points: • Deep learning image reconstruction "TrueFidelity" is superior to iterative reconstruction "ASIR-V" regarding image noise and sharpness. • The high-strength "TrueFidelity" approach generated the best image quality among the examined image reconstruction procedures. • In iterative and deep learning CT image reconstruction, the higher the blending and strength factors, the lower the image noise and the poorer the image sharpness.

Keywords: CT angiography; Deep learning; Image quality enhancement; Image reconstruction.

The electroencephalogram (EEG) signal analysis is a valuable tool in the evaluation of neurological disorders, which is commonly used for the diagnosis of epileptic seizures. This paper presents a novel automatic EEG signal classification method for epileptic seizure detection. The proposed method first employs a continuous wavelet transform (CWT) method for obtaining the time-frequency images (TFI) of EEG signals. The processed EEG signals are then decomposed into five sub-band frequency components of clinical interest since these sub-band frequency components indicate much better discriminative characteristics. Both Gaussian Mixture Model (GMM) features and Gray Level Co-occurrence Matrix (GLCM) descriptors are then extracted from these sub-band TFI. Additionally, in order to improve classification accuracy, a compact feature selection method by combining the ReliefF and the support vector machine-based recursive feature elimination (RFE-SVM) algorithm is adopted to select the most discriminative feature subset, which is an input to the SVM with the radial basis function (RBF) for classifying epileptic seizure EEG signals. The experimental results from a publicly available benchmark database demonstrate that the proposed approach provides better classification accuracy than the recently proposed methods in the literature, indicating the effectiveness of the proposed method in the detection of epileptic seizures.