Digital oral health biomarkers for early detection of cognitive decline.

BACKGROUND: Oral health could influence cognitive function by stimulating brain activity and blood flow. The quantified oral status from oral inflammation, frailty and masticatory performance were rarely applied to the cognitive function screening. We aimed to adopt non-invasive digital biomarkers to quantify oral health and employ machine learning algorithms to detect cognitive decline in the community. METHODS: We conducted a prospective case-control study to recruit 196 participants between 50 and 80 years old from Puzi Hospital (Chiayi County, Taiwan) between December 01, 2021, and December 31, 2022, including 163 with normal cognitive function and 33 with cognitive decline. Demographics, daily interactions, electronically stored medical records, masticatory ability, plaque index, oral diadochokinesis (ODK), periodontal status, and digital oral health indicators were collected. Cognitive function was classified, and confirmed mild cognitive impairment diagnoses were used for sensitivity analysis. RESULTS: The cognitive decline group significantly differed in ODK rate (P = 0.003) and acidity from SILL-Ha (P = 0.04). Younger age, increased social interactions, fewer cariogenic bacteria, high leukocytes, and high buffering capacity led to lower risk of cognitive decline. Patients with slow ODK, high plaque index, variance of hue (VOH) from bicolor chewing gum, and acidity had increased risk of cognitive decline. The prediction model area under the curve was 0.86 and was 0.99 for the sensitivity analysis. CONCLUSIONS: A digital oral health biomarker approach is feasible for tracing cognitive function. When maintaining oral hygiene and oral health, cognitive status can be assessed simultaneously and early monitoring of cognitive status can prevent disease burden in the future.

Environmental and personal factors for osteoporosis or osteopenia from a large health check-up database: a retrospective cohort study in Taiwan.

BACKGROUND: Osteoporosis is an important public health issue in aging societies because of its associated morbidity, mortality, and decreased quality of life. The study aims to identify the association of low bone mineral density, including osteoporosis and osteopenia, with environmental and personal factors. METHODS: The data of participants aged ≥ 20 years with multiple visits were obtained from a health check-up database in Taiwan from 2008 to 2016. Multivariable logistic regressions were performed to identify the selected factors associated with low bone mineral density for multiple visit data. RESULTS: A total of 194,910 participants with 359,943 visits were included in this study. The prevalence of low bone mineral density (BMD) in the study population was 10.6% (n = 20.615). Older women, ever and current smokers (odds ratio (OR) = 1.04 [95% confidence interval (CI) = 1.01, 1.08]), or participants who were underweight (OR = 1.72 [1.64, 1.81]), consumed a vegetarian diet (OR = 1.32 [1.25, 1.39]), or had higher triglyceride levels (OR = 1.04 [1.01, 1.06]) were significantly associated with a higher risk of low BMD. Participants who had higher educational years (OR = 0.43 [0.41, 0.46]), higher physical activity (OR = 0.93 [0.89, 0.97]), appropriate sleep duration and better quality (OR = 0.98 [0.97, 0.99]), dairy intake (≥ 1 slice of yogurt or cheese/week, OR = 0.97 [0.95, 0.99]), higher uric acid (OR = 0.93 [0.91, 0.95]), higher walkability (OR = 0.997 [0.995,0.999]), and higher solar radiation exposure (OR = 0.997 [0.97,0.99]) were significantly associated with a lower risk of low BMD. CONCLUSION: Interventions in different directions, such as having better health behaviors, increasing sun exposure, and residing in a highly walkable environment, are beneficial for reducing the risk of low BMD.

Association between local spatial accessibility of dental care services and dental care quality.

BACKGROUND: The aim of our study was to evaluate the allocation of dental resources and explore access to dental care in Taiwan. In addition, we tried to understand the spatiotemporal characteristics of dental care quality and analyze the relationship between dental care quality and areas with deficiencies in dental resources. METHODS: The study used a two-step floating catchment area to calculate the dental resources accessibility and explore the spatiotemporal distributions of dental care quality. The association between dental care quality and spatial accessibility was analyzed using a spatial error model. RESULTS: Most areas with deficient dental resources and lower dental care quality were remote townships, agricultural towns, or aging towns with spatial clustering. The quality of children's preventive dental care had increased over time. Most highly urbanized areas had higher dental care quality. The quality of some dental care types such as children's preventive care and full-mouth calculous removal was associated with higher accessibility. CONCLUSIONS: Understanding the spatiotemporal distribution of both dental care accessibility and quality can assist in allocation of dental care resources. Adequate dental resources may elevate dental care quality. Suggestions include policies to balance dental resources and routinely monitor improvement in areas with deficient dental care.

Association between periodontitis and all-cause and cancer mortality: retrospective elderly community cohort study.

BACKGROUND: Periodontal infection induces inflammation, which may increase the risk of tumor-promoting effects. The aim of this study was to assess the association between periodontitis and all-cause mortality, and all-cancer and specific cancers' mortality in a health examination cohort of the elderly in the communities. METHODS: A dataset of health examinations for the elderly with cause of death from 2005 to 2012 was obtained from the Department of Health, Taipei City Government. We enrolled 82,548 study participants with 262,035 visits. A Cox proportional hazards model and Cox frailty model were used for calculating the hazard ratios under different periodontal status by using SAS and Rstudio. RESULTS: Being male, elderly, having a low education level, and smoking were risk factors for mortality in this retrospective elderly community cohort study. Participants with periodontitis followed across time had significantly higher hazard ratios (HRs) for all-cause mortality and all-cancer mortality (HR = 1.092, 95% confidence interval (CI):1.038 to 1.149, HR = 1.114, 95% CI:1.032 to 1.203, respectively) in the Cox frailty models after adjusting for age, marital status, education level, sex, and smoking status. After adjusting for age and sex, the hazard ratio was 1.185 (95% CI: 1.027 to 1.368) for lung cancer mortality, and 1.340 (95% CI: 1.019 to 1.762) for prostate cancer mortality in the periodontitis group with each visit. CONCLUSIONS: The findings indicated that being male, having a low education level, and daily smoking were risk factors for mortality, and showed mixed evidence that periodontal disease is associated with all-cause, all-cancer and specific-cancer mortality including lung and prostate cancer. We suggest the importance of regular health screening in order to achieve early disease detection and lower mortality risk.

Sensitivity analysis of selection bias: a graphical display by bias-correction index.

Background: In observational studies, how the magnitude of potential selection bias in a sensitivity analysis can be quantified is rarely discussed. The purpose of this study was to develop a sensitivity analysis strategy by using the bias-correction index (BCI) approach for quantifying the influence and direction of selection bias. Methods: We used a BCI, a function of selection probabilities conditional on outcome and covariates, with different selection bias scenarios in a logistic regression setting. A bias-correction sensitivity plot was illustrated to analyze the associations between proctoscopy examination and sociodemographic variables obtained using the data from the Taiwan National Health Interview Survey (NHIS) and of a subset of individuals who consented to having their health insurance data further linked. Results: We included 15,247 people aged ≥20 years, and 87.74% of whom signed the informed consent. When the entire sample was considered, smokers were less likely to undergo proctoscopic examination (odds ratio (OR): 0.69, 95% CI [0.57-0.84]), than nonsmokers were. When the data of only the people who provided consent were considered, the OR was 0.76 (95% CI [0.62-0.94]). The bias-correction sensitivity plot indicated varying ORs under different degrees of selection bias. Conclusions: When data are only available in a subsample of a population, a bias-correction sensitivity plot can be used to easily visualize varying ORs under different selection bias scenarios. The similar strategy can be applied to models other than logistic regression if an appropriate BCI is derived.

Evaluating the Effectiveness of School Closure in COVID-19-Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study.

BACKGROUND: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. OBJECTIVE: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19-related syndromes in an outpatient syndromic surveillance system. METHODS: We calculated the incidence of COVID-19-related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19-related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. RESULTS: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19-related syndromes in 2021 for 2 weeks after the intervention (coefficient -1.24, 95% CI -2.40 to -0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ≥65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. CONCLUSIONS: Overall, school closure effectively suppresses COVID-19-related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home.

Unraveling the Uncharacterized Domain of Carocin S2: A Ribonuclease Pectobacterium carotovorum subsp. carotovorum Bacteriocin.

Carocin S2 is a bacteriocin with a low molecular weight generated by Pectobacterium carotovorum subsp. carotovorum 3F3 strain. The caroS2K gene, which is found in the genomic DNA alongside the caroS2I gene, which codes for an immunity protein, encodes this bacteriocin. We explored the residues responsible for Carocin S2's cytotoxic or RNA-se activity using a structure-based mutagenesis approach. The minimal antibiotic functional region starts at Lys691 and ends at Arg783, according to mutational research. Two residues in the identified region, Phe760 and Ser762, however, are unable to demonstrate this activity, suggesting that these sites may interact with another domain. Small modifications in the secondary structure of mutant caroS2K were revealed by circular dichroism (CD) spectroscopy and intrinsic tryptophan fluorescence (ITF), showing ribosomal RNA cleavage in the active site. A co-immunoprecipitation test indicated that the immunity protein CaroS2I binds to CaroS2K's C-terminus, while a region under the uncharacterized Domain III inhibits association of N-terminally truncated CaroS2K from interacting with CaroS2I. Carocin S2, a ribosomal ribonuclease bacteriocin, is the first to be identified with a domain III that encodes the cytotoxic residues as well as the binding sites between its immunity and killer proteins.

Impact of physical distancing policy on reducing transmission of SARS-CoV-2 globally: Perspective from government's response and residents' compliance.

BACKGROUND: COVID-19 was declared a public health emergency by the World Health Organization (WHO) in January 2020. Various physical distancing interventions were introduced to flatten the epidemic curve and reduce the disease burden. We evaluated the impacts of policy stringency and residents' compliance on time-varying reproduction number in 17 countries. METHODS: Data were from WHO reports of local transmission (February 28 to April 8, 2020) in Australia, Canada, Finland, France, Germany, Greece, Italy, Spain, Sweden, Thailand, the UK, US and Vietnam. Earlier local transmission data where available from press releases were added for Japan, South Korea, Singapore and Taiwan starting January 28, 2020. COVID-19 policy responses were from the Oxford Covid-19 Government Response Tracker with 17 indicators. Changes in people's behaviors were from Google's COVID-19 community mobility reports and Apple Maps' mobility trends reports. We estimated the daily time-varying reproduction number (Rt) by country. 0-, 7- and 14-day lagged effects of non-pharmaceutical interventions and changes in human mobility on Rt were estimated by linear mixed-effects models. RESULTS: Rt initially surged rapidly, then declined gradually depending on policy stringency. The highest mean policy stringency scores were for Italy (69.97) and South Korea (61.00). Variations in stringency scores were higher in Europe, the US and Australia than in Asia. The human mobility reduction was greater in countries with strict policies (median stringency score > = 50). In terms of immediate (0-day lag) effects, Rt reductions were found for workplace-closure, limited-gathering, and stay-at-home policies. At a 7-day lag, Rt reductions were found for workplace closure, restrictions on gatherings, stay-at-home requirements, international travel controls, contact tracing and reducing walking around. At a 14-day lag, Rt reductions were found for restrictions on gatherings, less visiting and staying in parks, and reduced walking around. CONCLUSION: The findings show physical distancing policies and residents' compliance can slow transmission, with the lag-to-effect time varying by policy.

Role of Chrysophanol in Epithelial-Mesenchymal Transition in Oral Cancer Cell Lines via a Wnt-3-Dependent Pathway.

Oral cancer belongs to the group of head and neck cancers. If not diagnosed or treated early, it can be life threatening. Epithelial-mesenchymal transition (EMT) plays an important role in tumor formation and progression. An increase in the presence of the EMT phenotype causes tumor cell proliferation, migration, invasion, and poor prognosis. Therefore, attenuating carcinogenesis via EMT inhibition is a good strategy. Herein, we will determine the pharmacological effects of chrysophanol on the EMT in FaDu cells. To analyze EMT, we detected the expression EMT markers, including α-SMA, ß-catenin, vimentin, N-cadherin, E-cadherin, phospho-GSK-3ß, and nuclear translocations of p65 and ß-catenin by western blotting. Additionally, accumulating evidence indicates that reactive oxygen species (ROS) mediate EMT. Our results showed that the level of ROS was significantly increased after chrysophanol treatment. We further speculated that chrysophanol-mediated EMT and metastasis are involved in the Wnt-3-dependent signaling pathway. The inhibition of the EMT phenotype and metastasis and accumulation of ROS caused by chrysophanol was reversed by treatment with the Wnt-3 agonist Bml 284. Therefore, our findings indicated that chrysophanol altered EMT formation, ROS accumulation, and metastasis via the Wnt-3-dependent signaling pathway.

Transesophageal echocardiography, more than a diagnostic tool: use during surgical ligation of coronary artery fistulae - a case report.

Coronary artery fistulae (CAF) are an infrequent coronary abnormality. Herein, we describe the use of intraoperative transesophageal echocardiography (TEE) in the treatment of CAF. A 61 year-old woman presented with chest pain and symptoms consistent with unstable angina. Subsequent coronary angiography revealed the presence of 2 CAF, one extending from the left anterior descending artery to the pulmonary artery (PA) and the other extending from the proximal right coronary artery to the PA. Surgical ligation of the CAF without coronary bypass was arranged. Intraoperative TEE was successfully employed to localize the CAF, monitor fistula blood flow and heart wall motion, and confirm successful ligation. The patient recovered without complications. This case highlights the utility of intraoperative TEE during ligation of CAF.

Arachidin-1, a peanut stilbenoid, induces programmed cell death in human leukemia HL-60 cells.

The stilbenoids, arachidin-1 (Ara-1), arachidin-3, isopentadienylresveratrol, and resveratrol, have been isolated from germinating peanut kernels and characterized as antioxidant and anti-inflammatory agents. Resveratrol possesses anticancer activity, and studies have indicated that it induces programmed cell death (PCD) in human leukemia HL-60 cells. In this study, the anticancer activity of these stilbenoids was determined in HL-60 cells. Ara-1 had the highest efficacy in inducing PCD in HL-60 cells, with an approximately 4-fold lower EC50 than resveratrol. Ara-1 treatment caused mitochondrial membrane damage, activation of caspases, and nuclear translocation of apoptosis-inducing factor, resulting in chromosome degradation and cell death. Therefore, Ara-1 induces PCD in HL-60 cells through caspase-dependent and caspase-independent pathways. Ara-1 demonstrates its efficacy as an anticancer agent by inducing caspase-independent cell death, which is an alternative death pathway of cancer cells with mutations in key apoptotic genes. These findings indicate the merits of screening other peanut stilbenoids for anticancer activity.