Impact of Weight Loss During Chemotherapy in Chinese Patients with Unresectable Pancreatic Cancer

Background: Weight loss is frequently observed in pancreatic cancer patients. We aimed to study the prognostic impacts of weight loss early during chemotherapy.

Methods: A total of 72 patients of Chinese ethnicity with unresectable pancreatic cancer who underwent chemotherapy were reviewed. Critical weight loss (CWL) was defined as weight loss ≥ 5% within one month after treatment. The prognostic impact of weight loss and CWL were analyzed.

Results: 47 patients (65.3%) had weight loss after one month of treatment, with 14 (19.4%) suffering from CWL. Baseline characteristics were similar between patients with and without CWL. The median OS and Time-to-treatment-failure (TTF) of patients with CWL were shorter than those without CWL (OS: 4.8?months [CWL] versus [vs.] OS 7.1?months [No CWL]; TTF 1.6?months [CWL] vs. 3.2?months [No CWL]; both P?<?0.01). CWL was an independent adverse prognosticator for OS (Hazard Ratio [HR]?=?2.50; P?=?0.01) and TTF (HR = 2.71; P?<?0.01). Other independent prognosticators for OS were serum albumin <35?mg/dl and CA19-9?≥?1000?IU/ml, while CWL was the only independent prognosticator for TTF (HR 2.71 [95% CI 1.33–5.52]; P?<?0.01).

Conclusions: Development of CWL in early course of chemotherapy was associated with worse prognosis in Chinese patients with unresectable pancreatic cancers.     

Age,period, and cohort analysis of regular dental care behavior and edentulism: A marginal approach

Background

Microbial communities inhabiting human mouth are associated with oral health and disease. Previous studies have indicated the general prevalence of adult gingivitis in China to be high. The aim of this study was to characterize in depth the oral microbiota of Chinese adults with or without gingivitis, by defining the microbial phylogenetic diversity and community-structure using highly paralleled pyrosequencing.

Methods

Six non-smoking Chinese, three with and three without gingivitis (age range 21-39 years, 4 females and 2 males) were enrolled in the present cross-sectional study. Gingival parameters of inflammation and bleeding on probing were characterized by a clinician using the Mazza Gingival Index (MGI). Plaque (sampled separately from four different oral sites) and salivary samples were obtained from each subject. Sequences and relative abundance of the bacterial 16 S rDNA PCR-amplicons were determined via pyrosequencing that produced 400 bp-long reads. The sequence data were analyzed via a computational pipeline customized for human oral microbiome analyses. Furthermore, the relative abundances of selected microbial groups were validated using quantitative PCR.

Results

The oral microbiomes from gingivitis and healthy subjects could be distinguished based on the distinct community structures of plaque microbiomes, but not the salivary microbiomes. Contributions of community members to community structure divergence were statistically accessed at the phylum, genus and species-like levels. Eight predominant taxa were found associated with gingivitis: TM7, Leptotrichia, Selenomonas, Streptococcus, Veillonella, Prevotella, Lautropia, and Haemophilus. Furthermore, 98 species-level OTUs were identified to be gingivitis-associated, which provided microbial features of gingivitis at a species resolution. Finally, for the two selected genera Streptococcus and Fusobacterium, Real-Time PCR based quantification of relative bacterial abundance validated the pyrosequencing-based results.

Conclusions

This methods study suggests that oral samples from this patient population of gingivitis can be characterized via plaque microbiome by pyrosequencing the 16 S rDNA genes. Further studies that characterize serial samples from subjects (longitudinal study design) with a larger population size may provide insight into the temporal and ecological features of oral microbial communities in clinically-defined states of gingivitis.     

A 10-year comparative study of the incidence of third molar removal in the aging population.

PURPOSE: The study goal was to evaluate the incidence of patients older than 40 years who required third molar removal. PATIENTS AND METHODS: Two prospective 5-year studies were compared over a 10-year period of 1992 to 1997 and 1997 to 2002. The study was initiated to evaluate how the large increase in the older population with longer life expectancies is reflected in the third molar population. RESULTS: In 1997, 10.5% of patients requiring third molar surgery were 40 years or older. In 2002, 17.3% of patients were 40 years or older. CONCLUSIONS: It is well known that patients 40 years and older have increased risk in removal of third molars. It is concluded that 1 patient in 5 in the high-risk category is in a very high risk category. The risk to patients and to the profession can be dramatically reduced by considering early removal of abnormal third molars.     

Small mouths ... Big problems? A review of scleroderma and its oral health implications

Scleroderma, or progressive systemic sclerosis (PSS), an autoimmune rheumatic condition affecting the connective tissues, has a profound impact on oral health. Common orofacial findings include xerostomia, gastroesophageal reflux disease and limited mouth opening. This review article describes scleroderma, or PSS, and its various manifestations. The features of CREST syndrome and morphea are reviewed. Concerns relevant to the prevention of dental disease and the safe delivery of dental care in this group of challenging patients are emphasized.     

The accuracy of 4 panoramic units in the projection of mesiodistal tooth angulations.

The purpose of this study was to compare the mesiodistal tooth angulations determined with a typodont/skull testing device with the images of mesiodistal tooth angulations from 4 contemporary panoramic units (OP 100, Cranex 3+, Orthophos, PM 2002 EC). A typodont testing device was constructed, and the true mesiodistal tooth angulations relative to an orthodontic archwire were determined with a 3-dimensional coordinate-measuring machine and custom-designed software. A human skull served as the matrix into which the typodont was fixed for imaging. The skull was repeatedly imaged and repositioned 5 times for each panoramic unit. The images were scanned and digitized with custom software to determine the image mesiodistal angulations. Results revealed that the majority of image angles from the 4 panoramic units were statistically significantly different from the true angle measurements. However, definite trends were noted among the panoramic units. For the maxillary teeth, the images projected the anterior roots more mesially and the posterior roots more distally, creating the appearance of exaggerated root divergence between the canine and the first premolar. For the mandibular teeth, the images projected almost all roots more mesially than they really were, with the canine and the first premolar the most severely affected. The largest angular difference for adjacent teeth occurred between the mandibular lateral incisor and the canine, with relative root parallelism projected as root convergence. It was concluded that the clinical assessment of mesiodistal tooth angulation with panoramic radiography should be approached with extreme caution and with an understanding of the inherent image distortions.     

Use of pre-operative steroids in liver resection: a systematic review and meta-analysis

Background

By attenuating the systemic inflammatory response to major surgery, the pre-operative administration of steroids may reduce the incidence of complications.

Methods

A systematic review was conducted to identify randomized controlled trials (RCT) comparing pre-operative steroid administration with placebo during a liver resection. Meta-analyses were performed.

Results

Five RCTs were identified including a total of 379 patients. Pre-operative steroids were associated with statistically significant reductions in the levels of serum bilirubin and interleukin 6 (IL-6) on post-operative day one. There was a trend towards a lower incidence of post-operative complications and prothrombin time (PT), but this did not reach statistical significance.

Conclusion

Pre-operative steroids may be associated with a clinically significant benefit in liver resection.     

A Critical Role for Thioredoxin-Interacting Protein in Diabetes-Related Impairment of Angiogenesis

Impaired angiogenesis in ischemic tissue is a hallmark of diabetes. Thioredoxin-interacting protein (TXNIP) is an exquisitely glucose-sensitive gene that is overexpressed in diabetes. As TXNIP modulates the activity of the key angiogenic cytokine vascular endothelial growth factor (VEGF), we hypothesized that hyperglycemia-induced dysregulation of TXNIP may play a role in the pathogenesis of impaired angiogenesis in diabetes. In the current study, we report that high glucose–mediated overexpression of TXNIP induces a widespread impairment in endothelial cell (EC) function and survival by reducing VEGF production and sensitivity to VEGF action, findings that are rescued by silencing TXNIP with small interfering RNA. High glucose–induced EC dysfunction was recapitulated in normal glucose conditions by overexpressing either TXNIP or a TXNIP C247S mutant unable to bind thioredoxin, suggesting that TXNIP effects are largely independent of thioredoxin activity. In streptozotocin-induced diabetic mice, TXNIP knockdown to nondiabetic levels rescued diabetes-related impairment of angiogenesis, arteriogenesis, blood flow, and functional recovery in an ischemic hindlimb. These findings were associated with in vivo restoration of VEGF production to nondiabetic levels. These data implicate a critical role for TXNIP in diabetes-related impairment of ischemia-mediated angiogenesis and identify TXNIP as a potential therapeutic target for the vascular complications of diabetes.