Assessing the stability of polyphenol content in red rooibos herbal tea using traditional methods and high-resolution mass spectrometry: Implications for studying dietary interventions in preclinical rodent studies.

Preclinical rodent models are used to examine the relationship between tea consumption and bone health, where tea is available for rodents and typically replaced weekly. However, the extent to which the tea polyphenols change over time remains uncertain, despite its importance in preparing tea during preclinical rodent trials. Using an untargeted molecular approach, we applied a liquid chromatography quadrupole-time-of-flight mass spectrometry (LC-QTOFMS) system to assess the molecular profile of red rooibos teas throughout a 6-day aging period. We found a significant, 3-fold decrease of polyphenols involved in bone metabolism, including m-coumaric acid, catechin derivatives and courmaroyl tartaric acid over 6 days, likely due to photochemical decomposition and autooxidation within tea extracts. Using a novel untargeted workflow for polyphenol characterization, our findings revealed the complexity of polyphenols in red rooibos teas that can inform the evidence-based decisions of how often to change teas during in vivo rodent trials.

Maternal Exposure to Red Rooibos Does Not Alter Bone Development in Male or Female Sprague-Dawley Rat Offspring.

Maternal diet during pregnancy and/or throughout lactation provides a potential opportunity for nutritional programming of offspring bone development. Objectives of this study were to determine whether maternal consumption of red rooibos (RR) throughout pregnancy and lactation improved bone mineral density (BMD), bone structure, and bone strength in offspring and to determine potential sex-specific responses. Female Sprague-Dawley rats were randomly assigned to control water or RR in water (2600 mg/kg body weight/d) from prepregnancy through to the end of lactation. At weaning, offspring were fed AIN-93G diet until age 3 mo. Longitudinal assessment of the tibia demonstrated that maternal exposure to RR did not alter the trajectory of BMD or bone structure in male or female offspring compared with sex-specific controls at age 1, 2, or 3 mo or bone strength at age 3 mo. In conclusion, maternal exposure to RR did not program bone development in male or female offspring.

Pregnancy and Lactation in Sprague-Dawley Rats Result in Permanent Reductions of Tibia Trabecular Bone Mineral Density and Structure but Consumption of Red Rooibos Herbal Tea Supports the Partial Recovery.

During pregnancy and lactation, maternal bone mineral density (BMD) is reduced as calcium is mobilized to support offspring bone development. In humans, BMD returns to pre-pregnancy levels shortly after delivery, shifting from a high rate of bone resorption during pregnancy and lactation, into a rapid phase of bone formation post-lactation. This rapid change in bone turnover may provide an opportunity to stimulate a greater gain in BMD and stronger trabecular and cortical structure than present pre-pregnancy. Providing polyphenols present in red rooibos herbal tea may promote such an effect. In vitro, red rooibos polyphenols stimulate osteoblast activity, reduce osteoclastic resorption, and increase mineral production. The study objective was to determine if consuming red rooibos from pre-pregnancy through to 4 months post-lactation resulted in a higher BMD and improved trabecular and cortical bone structure in a commonly used rat model. Female Sprague-Dawley rats (n = 42) were randomized to one of the following groups: PREG TEA (pregnant, received supplemental level of red rooibos in water: ~2.6 g /kg body weight/day in water), PREG WATER (pregnant, received water), or NONPREG CON (age-matched, non-pregnant control, received water) from 2 weeks pre-pregnancy (age 8 weeks) through to 4 months post-lactation. Rats were fed AIN-93G (pre-pregnancy through to the end of lactation) and AIN-93M (post-lactation onwards). BMD and trabecular structure (bone volume fraction, trabecular number, trabecular separation) were improved (p < 0.05) by 1- or 2-months post-lactation when comparing PREG TEA to PREG CON, though neither group recovered to the level of NONPREG CON. Cortical outcomes (cortical area fraction, cortical thickness, tissue mineral density) for PREG TEA and PREG CON were reduced (p < 0.05) following lactation but returned to the level of NONPREG CON by 2-months post-lactation, with the exception of cortical thickness. The lack of recovery of BMD and key outcomes of trabecular bone structure was unexpected. While consumption of red rooibos did not result in stronger bone post-lactation, red rooibos did support the partial recovery of trabecular BMD and bone structure following pregnancy and lactation. The findings also provide insight into the timing and dose of polyphenols to study in future interventions.

Improved Healing after Non-Surgical Periodontal Therapy Is Associated with Higher Protein Intake in Patients Who Are Non-Smokers.

The aim of this study was to determine whether a relationship between periodontal healing and protein intake exists in patients undergoing non-surgical treatment for periodontitis. Dietary protein intake was assessed using the 2005 Block food frequency questionnaire in patients with chronic generalized periodontitis undergoing scaling and root planing (n = 63 for non-smokers, n = 22 for smokers). Protein intake was correlated to post-treatment probing depth using multiple linear regression. Non-smoking patients who consumed ≥1 g protein/kg body weight/day had fewer sites with probing depth ≥ 4 mm after scaling and root planing compared to patients with intakes <1 g protein/kg body weight/day (11 ± 2 versus 16 ± 2, p = 0.05). This relationship was strengthened after controlling for baseline probing depth, hygienist and time between treatment and follow-up (10 ± 2 versus 16 ± 1, p = 0.018) and further strengthened after controlling for potential confounders including age, sex, body mass index, flossing frequency, and bleeding on probing (8 ± 2 versus 18 ± 2, p < 0.001). No associations were seen in patients who smoked. Consuming ≥1 g protein/kg body weight/day was associated with reductions in periodontal disease burden following scaling and root planing in patients who were non-smokers. Further studies are needed to differentiate between animal and plant proteins.

JAK2-IGF1 axis in osteoclasts regulates postnatal growth in mice.

Osteoclasts are specialized cells of the hematopoietic lineage that are responsible for bone resorption and play a critical role in musculoskeletal disease. JAK2 is a key mediator of cytokine and growth factor signaling; however, its role in osteoclasts in vivo has yet to be investigated. To elucidate the role of JAK2 in osteoclasts, we generated an osteoclast-specific JAK2-KO (Oc-JAK2-KO) mouse using the Cre/Lox-P system. Oc-JAK2-KO mice demonstrated marked postnatal growth restriction; however, this was not associated with significant changes in bone density, microarchitecture, or strength, indicating that the observed phenotype was not due to alterations in canonical osteoclast function. Interestingly, Oc-JAK2-KO mice had reduced osteoclast-specific expression of IGF1, suggesting a role for osteoclast-derived IGF1 in determination of body size. To directly assess the role of osteoclast-derived IGF1, we generated an osteoclast-specific IGF1-KO mouse, which showed a similar growth-restricted phenotype. Lastly, overexpression of circulating IGF1 by human transgene rescued the growth defects in Oc-JAK2-KO mice, in keeping with a causal role of IGF1 in these models. Together, our data show a potentially novel role for Oc-JAK2 and IGF1 in the determination of body size, which is independent of osteoclast resorptive function.

The Relationship Between Polycystic Ovarian Syndrome, Periodontal Disease, and Osteoporosis.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder to affect women in their reproductive years. There has been growing concern that women with PCOS may suffer from long-term metabolic consequences due to the high degree of insulin resistance that is often present in PCOS. However, few longitudinal studies exist in this area and there is a paucity of data on whether women with PCOS are at risk of other chronic diseases as they age. Specifically, current evidence suggests that reproductive-age women with PCOS may be at increased risk for both osteoporosis and periodontal disease (PD)-both these chronic diseases can have serious implications for health and quality of life. However, few studies have addressed how risk factors for osteoporosis and PD may be altered by aging in PCOS. The PCOS phenotype of women beyond reproductive years is poorly understood, and it is not known whether the metabolic profile of older women with PCOS results in an increased risk of osteoporosis and PD. The objective of this review is to discuss the relationships between PCOS, osteoporosis, and PD, and how these relationships could be impacted during aging. The long-term goal of this review is to provide direction for future research that is needed to more clearly elucidate these relationships and eventually provide a basis for evidence-based health recommendations.

Patients undergoing periodontal procedures commonly use dietary supplements: A consideration in the design of intervention trials.

OBJECTIVE: Diet and dietary supplement use are associated with periodontal health while a cause and effect relationship is less clear. Although associations with specific nutrients and supplements suggest a potential benefit to healing of periodontal tissues after periodontal procedures, this study determined if patients undergoing periodontal surgery currently take dietary supplements to gage whether patients may accept use of such supplements as a potential intervention. MATERIALS AND METHODS: Patients who were undergoing implant placement or soft tissue graft surgery completed a questionnaire indicating any dietary supplements they consumed. Patient demographics, such as age, sex, and smoking status, were gathered from patients' charting records. RESULTS: Data on dietary supplement usage were collected from 221 patients. More than half (64.7%) the population surveyed reported using one or more dietary supplements. The most commonly used dietary supplements were vitamin D (31%), multivitamin (28%), and B-complex (17.2%). Females were more likely to be taking calcium, vitamin B12, and magnesium than males. Adults, aged 51 years and older, were more likely to be taking dietary supplements than their younger counterparts. They were also more likely to be taking four or more supplements than those under the age of 50 years. There was no association between supplement use and sex, but when the number of different supplements being used was assessed, females were more likely than males to be taking four or more different supplements. CONCLUSIONS: The majority of the study population is already taking dietary supplements as part of their routine. Based on this study, future studies to determine if supplement usage, potentially at levels higher than current levels of intake, can be used to maintain or promote periodontal health seem highly feasible.

Black and Green Tea as Well as Specialty Teas Increase Osteoblast Mineralization with Varying Effectiveness.

Many human studies suggest a benefit of tea consumption on bone health. The study objective was to compare the ability of different tea types to promote mineralization. Saos-2 cells underwent mineralization (5 days) in the presence of tea (white: WT, green: GT, black: BT, green rooibos: GR, or red rooibos: RR; 1 µg/mL of polyphenols) or control. Total polyphenol content (TPC, Folin-Ciocalteu's reagent), antioxidant capacity (2,2-diphenyl-1-picrylhydrazyl [DPPH] scavenging), mineralization (Alizarin Red staining), gene expression quantitative reverse transcription PCR (RT-qPCR), and cell activity (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay) were determined. TPC was highest in GT and BT. The ability of each tea to inhibit DPPH also differed (WT, GT > RR) after normalizing for polyphenol quantity. Each tea increased mineralization and differences were observed among types (GT/BT/GR/RR > WT, GT = BT = GR, RR > BT/GT). mRNA expression of alkaline phosphatase (ALP) and ectonucleotide pyrophosphatase/phosphodiesterase (NPP1) remained unchanged, whereas osteopontin (OPN) and sclerostin (SOST) were reduced in cells treated with tea, regardless of type. At 24- and 48-h postexposure to tea, cell activity was greater in cells receiving any of the teas compared with vehicle control. Supplementation increased mineralization regardless of tea type with both rooibos teas and black tea stimulating greater mineralization than WT, whereas green tea is similar to the others. While future study is needed to confirm in vivo effects, the results suggest that consuming any of the teas studied may benefit bone health.

Dairy product intake decreases bone resorption following a 12-week diet and exercise intervention in overweight and obese adolescent girls.

BACKGROUND: We examined whether increased dairy intake was associated with changes in the levels of bone-related biochemical markers in overweight/obese adolescent girls undergoing a 12-week diet and exercise intervention. METHODS: Thirty-five girls were assigned to a low dairy group (LDa; 0-2 servings/day; n = 16) or a higher dairy group (RDa; 4 servings/day; n = 19). Morning, fasted/resting blood samples were collected before and after the intervention and serum concentrations of procollagen-type-1-N-terminal-propeptide (P1NP), ß-isomerized-C-terminal-cross-linking-telopeptides (ß-CTX), osteocalcin (OC), 25-hydroxyvitamin-D, sclerostin and parathyroid hormone were measured. RESULTS: At baseline, there were no significant differences between groups in any bone variable. Changes (∆) over time in ß-CTΧ (p = 0.035; interaction) and OC (p = 0.015; interaction) were significantly different between groups characterized by decreases in RDa and increases in LDa. P1NP and P1NP:ß-CTX ratio decreased in both groups (main time effects: p = 0.003, p = 0.041, respectively). ∆ß-CTX (r = -0.37; p = 0.028) and ∆OC (r = -0.39; p = 0.021) were correlated with average number of dairy servings consumed during the study and with each other (r = 0.45; p = 0.006). ∆OC was not correlated with ∆P1NP (r = 0.19; p = 0.27). CONCLUSIONS: Our results suggest that the osteogenic response to a diet and exercise program in this population can be improved with increased dairy intake via a decrease in bone resorption. IMPACT: We demonstrated that bone resorption significantly decreased over the intervention period in the group consuming adequate levels of dairy products compared to the group consuming little to no dairy products. Change in bone resorption was negatively correlated with average number of dairy servings consumed during the study. Our results suggest that the osteogenic response to a diet and exercise program in this population can be improved with increased dairy intake via a decrease in bone resorption. This is the first study to date to assess changes in bone marker status following a lifestyle intervention with exercise and different intakes of dairy products in a sample of OW/OB adolescent girls. We provide evidence that increased dairy product intake is associated with beneficial changes in circulating levels of bone-related biochemical markers in these girls undergoing a 12-week lifestyle (nutrition counseling and exercise training) intervention program. The main impact of our work relates particularly to the recent changes to Canada's food guide. Using the old recommendations, we demonstrated that the inclusion of 3-4 servings of mixed dairy foods per day improved bone health (primarily as a decrease in resorption) in OW/OB adolescent girls and that this level of dairy product intake appears appropriate and should still be encouraged for this age group. We also demonstrated that adolescent girls, a group that usually does not sufficiently consume dairy products, also improved their BMI percentile and nutrient intake with the inclusion of dairy products in their diets.

Black Tea Exhibits a Dose-Dependent Response in Saos-2 Cell Mineralization.

Higher bone mineral density (BMD) is often associated with greater consumption of black tea (BT). However, the dose-response of BT on mineralization in an osteoblast cell model has not yet been studied. The study objective was to determine the dose-dependent response of BT in Saos-2 cells and investigate changes to several proteins involved in the mineralization process. Mineralization was induced in the presence of BT at concentrations that represent levels likely achieved through daily consumption (0.1, 0.5, 0.75, 1 µg gallic acid equivalents [GAE]/mL) or through supplementation (2, 5, or 10 µg GAE/mL). BT exerted a positive dose-response on bone mineralization, peaking at 1 µg GAE/mL of BT (P < .05). Cellular activity was significantly greater than control with exposure to 2-10 µg GAE/mL of BT (at 24 h) (P < .05) and 1-10 µg GAE/mL (at 48 h) (P < .05), with a peak at 5 µg GAE/mL at 24 and 48 h (P < .05). Protein expression of alkaline phosphatase and ectonucleotide pyrophosphatase/phosphodiesterase-1 were unchanged, whereas a moderate dose of BT (0.75 µg GAE/mL) resulted in greater expression of osteopontin compared with the highest dose (10 µg GAE/mL) (P < .05). Doses of BT from 0.5 to 10 µg GAE/mL resulted in higher antioxidant capacity compared with control (P < .05). In summary, the higher antioxidant capacity, enhanced cell viability, and upregulated mineralization suggest that consumption of BT may have a positive effect on BMD at levels obtained through consumption of tea.

Higher intakes of flavonoids are associated with lower salivary IL-1ß and maintenance of periodontal health 3-4 years after scaling and root planing.

AIMS: Higher intakes of fruits and vegetables, and vitamin C are associated with improved periodontal healing post-scaling and root planing (SRP). This study determined if this association was sustained at 3-4 years post-SRP, and if flavonoid intake is associated with periodontal health. Whether reduced probing depth (PD) is sustained and whether PD is correlated with salivary IL-1ß, IL-6 and CRP at 3-4 years post-SRP were also studied. MATERIALS AND METHODS: Clinical periodontal outcomes, dietary intakes and salivary markers of inflammation were measured in patients (n = 43, 23 females, 37-93 years) who had undergone SRP 3-4 years earlier and had been part of a periodontal maintenance programme. RESULTS: Flavonoid intake was inversely associated with PD (p = .042) and salivary IL-1ß concentration (p = .015) after adjustment for multiple confounders. When changes in PD were considered, the association of flavonoid intake with reduced PD became borderline significant (p = .051) but persisted for IL-1ß (p = .018). PD at 3-4 years and 2-4 months post-SRP was similar. There was a positive correlation between PD and salivary IL-1ß (p = .005) but not with salivary CRP and IL-6. CONCLUSION: Higher flavonoid intake is associated with lower IL-1ß. Also, regular supportive periodontal therapy maintained the improved PD at 3-4 years post-SRP regardless of smoking status.

Characteristics of clear cell renal cell carcinoma metastases to the thyroid gland: A systematic review.

BACKGROUND: Thyroid gland is an uncommon site for metastases from clear cell renal cell carcinoma (CCRCC) and literature is scarce. Due to the variable and often long lag time before development of metastases in patients with CCRCC, thyroid nodules may be misdiagnosed initially as benign. This systematic review aims at a better understanding of the nature of these metastases. METHODS: A bibliographic search was performed using PubMed (1990-2019), key words being "renal cell carcinoma, thyroid, kidney cancer, clear cell." 147 cases were analyzed. The patient's characteristics assessed were: age, sex, stage, size of metastases, lag time, diagnostic modality, initial symptoms, treatment and outcome in last documented follow up. Binary logistic regression, Spearman's rho and ANOVA were used to identify differences between the existing variables. RESULTS: The mean age (± SD) was 64 ± (10) years in males and 64 (± 11) in females. The mean lag time to diagnosis of thyroid metastases was 8.7 (± 6.3) years. Gender distribution of the patients was 46.3% male, 52.4% female. There was a weak correlation between lag time and size of metastases, not statistically significant. Size of metastases was significantly higher in symptomatic patients (6.06 ± 3.51 cm) compared to those with painless mass (4.6 ± 0.29 cm) and asymptomatic ones (3.93 ± 1.99 cm) (P = 0.03). Fine Needle Aspiration was diagnostic in 29.4% of cases, 47.1% were non diagnostic. Most patients (80.3%) underwent thyroid surgery. At 1 year follow up, 55.6% of patients operated were alive versus 35.3% who did not have surgery, though this was not statistically significant (P = 0.1). CONCLUSION: A larger size of thyroid metastasis was more likely to present with symptomatology. A high index of suspicion is warranted when evaluating thyroid nodules in CCRCC patients. There was no significant difference in outcome between patients who underwent surgery and those who did not. With the wider use of immune check-point inhibitors and tyrosine kinase inhibitors in metastatic CCRCC, surgery may eventually be reserved only for palliative purposes.

First-year university is associated with greater body weight, body composition and adverse dietary changes in males than females.

BACKGROUND: The transition from high school to university life is a critical time for change, often accompanied by the adoption of negative lifestyle habits including unhealthy nutrition. The purpose of this longitudinal study was to identify sex-specific changes in dietary intake and diet quality, and associated changes in body weight and composition during first-year university. METHODS: Three-hundred and one students (n = 229 females) completed food frequency questionnaires, and had their body weight, body composition, waist and hip circumference measured at the beginning and end of first-year university. Repeated-measures ANOVAs with covariate adjustments were used with variables for sex (between group) and time (within group) to assess these changes. RESULTS: Students gained body weight and fat during the year (p<0.001). Body mass Index (BMI) also significantly increased (p = 0.032). Males gained more weight (Male:3.8 kg; Female:1.8 kg), fat mass (Male:2.7 kg; Female:1.5 kg), lean mass (Male:1.1 kg; Female:0.3 kg) and BMI (Male:1.2 kg/m2; Female:0.7 kg/m2; p≤0.001 for interactions), and had greater increases in waist circumference (Male:2.7 cm; Female:1.1 cm) and waist:hip ratio (Male:0.02; Female:0.004; p<0.05 for interactions) than females. Energy intake remained the same over the year in both sexes, accompanied by an increase in alcohol (ethanol) in both sexes but more so in males than females (p = 0.011 interaction). Diet quality decreased, characterized by a reduced intake of healthy foods/beverages (p<0.05) in both sexes such as yogurt, cheese, oatmeal, breads, rice, pasta, vegetables, green salad, fruits, steak, fish, nuts and milk, and an increased consumption of unhealthy foods and beverages (p<0.05) such as donuts/cakes, fried chicken, beer and liquor. Significant interactions between sexes indicated that males displayed a more adverse and lower quality eating pattern which included greater intakes of donuts/cakes, fried chicken, beer and liquor, as well as decreased intakes of eggs and vegetables compared to females. Lastly, some dietary intake changes significantly correlated with fat mass and waist circumference change indicating that poor dietary choices were associated with increased adiposity. CONCLUSIONS: Our study demonstrated that during first-year university, both male and female students undergo unfavorable changes in nutrition and body weight/composition that significantly differ between sexes, with males showing more adverse changes. Our results can be used to inform effective sex-specific strategies and interventions to improve dietary habits during the transition to university life.

Cytokine and Sclerostin Response to High-Intensity Interval Running versus Cycling.

PURPOSE: This study examined whether the exercise-induced changes in inflammatory cytokines differ between impact and no-impact high-intensity interval exercise, and whether they are associated with postexercise changes in sclerostin. METHODS: Thirty-eight females (n = 19, 22.6 ± 2.7 yr) and males (n = 19, 22.3 ± 2.4 yr) performed two high-intensity interval exercise trials in random order (crossover design): running on a treadmill and cycling on a cycle ergometer. Trials consisted of eight repetitions of 1 min running or cycling at ≥90% maximal heart rate, separated by 1 min passive recovery intervals. Blood was collected preexercise and 5 min, 1 h, 24 h, and 48 h postexercise, and it was analyzed for serum levels of interleukins (IL-1ß, IL-6, and IL-10), tumor necrosis factor alpha (TNF-α), and sclerostin. RESULTS: Inflammatory cytokines significantly increased over time in both sexes with some differences between trials. Specifically, IL-1ß significantly increased from pre- to 5 min after both trials (23%, P < 0.05), IL-6 increased 1 h after both trials (39%, P < 0.05), IL-10 was elevated 5 min after running (20%, P < 0.05) and 1 h after both running and cycling (41% and 64%, respectively, P < 0.05), and TNF-α increased 5 min after running (10%, P < 0.05). Sclerostin increased 5 min after both trials, with a greater increase in males than that in females (62 vs 32 pg·mL in running, P = 0.018; 63 vs 30 pg·mL in cycling, P = 0.004). In addition, sclerostin was significantly correlated with the corresponding changes in inflammatory cytokines, and 34% of the variance in its postexercise gain score (Δ) was explained by sex and the corresponding gain scores in TNF-α, which was the strongest predictor. CONCLUSION: A single bout of either impact or no-impact high-intensity exercise induces changes in inflammatory cytokines, which are associated with the postexercise increase in sclerostin.

Research in nutritional supplements and nutraceuticals for health, physical activity, and performance: moving forward 1.

This Horizons is part of a series that identifies key, forward-thinking research questions and challenges that need to be addressed. Specifically, this Horizons paper discusses research in nutritional supplements and nutraceuticals for health, physical activity, and performance, and is the product of a discussion by an expert panel that took place in January 2018 prior to the Canadian Nutrition Society Thematic Conference "Advances in Sport Nutrition from Daily Living to High Performance Sport". The objective of this Horizons paper was to identify core considerations for future studies for this research area, and how scientists can be leaders in the field to ensure the best quality science is available for decision makers. It is strongly recommended that the various elements highlighted throughout this Horizons paper will increase the awareness of the significant before-, during-, and after-research due-diligence required to produce research of the highest quality. While it is recognized that many scientists will not be able to meet all of these aspects, it is nonetheless important to consider the points outlined and to recognize that those elements that are not met in studies may be significant limitations. Highlights Research questions that are hypothesis-driven are the strongest, and when combined with careful planning of the study, the result will often be of the best quality. Studies with a strong experimental design help discern between evidence-based findings and those that have not been substantiated.

Pregnancy unmasking symptoms of undiagnosed lymphangioleiomyomatosis: Case report and review of literature.

Cystic lung diseases are a group of disorders that appear similar on radiological studies on chest computed tomography. Each disorder is characterized by its own etiology, pathophysiology, course of progression and manifestation. Lymphangioleiomyomatosis (LAM) is one of the cystic lung diseases that can either be hereditary or sporadic. The sporadic form is a rare disease with no accurate prevalence reported but is believed to be less than 10 per million. LAM is associated with inappropriate activation of mammalian target of rapamycin (mTOR) signaling which regulates cellular growth. The sporadic form is almost confined to premenopausal female population and estrogen is believed to play an important role in the pathogenesis. Pregnancy and use of estrogen based oral contraceptives can aggravate symptoms of already existing LAM. Here we describe a case of LAM that was previously treated as asthma and was diagnosed after exacerbation of respiratory symptoms after pregnancy. We offer a review of the medical literature regarding the etiology, clinical course, diagnosis and treatment of LAM.

A Cross-Sectional Study of Early Childhood Educators' Childhood and Current Food Insecurity and Dietary Intake.

In this cross-sectional study, ECEs (N=307) completed an 18-item survey regarding their role (lead vs. assistant), Education level, Program Type, and Current and Childhood Food Insecurity (FI) and Dietary Intake. ECEs in this study reported poor dietary quality and a high rate of FI. Approximately one quarter of ECEs ate fruits and vegetables more than once per day. Of participating ECEs, 34.5% indicated Current FI and 28.7% reported experiencing FI in Childhood. Differences in prevalence of Current FI were found for ECE role, Program Type, and Education (all p ≤ .03). Regression models with Childhood Dietary Intake, Childhood FI, Education, and Program Type as predictors accounted for a significant portion of variance in Current Dietary outcomes. In both models, Childhood Dietary Intake was uniquely predictive (p < .001) although Program Type was not. Future training and education efforts for ECEs should consider including specific resources to assess and reduce ECE FI and provide practical support for healthy eating on a budget. Additional research is needed to determine the impact of ECE FI on a variety of educator and child outcomes.

Investigation of factors that influence pain experienced and the use of pain medication following periodontal surgery.

AIMS: To determine the relationship between anticipated pain and actual pain experienced following soft tissue grafting or implant surgery; to identify the factors that predict actual pain experienced and the use of pain medication following soft tissue grafting or implant surgery. MATERIALS AND METHODS: Prior to dental implant placement (n = 98) or soft tissue grafting (n = 115) and for seven days following the procedure, patients completed a visual analog scale indicating anticipated or experienced pain, respectively. The use of pain medication and alcohol, and smoking were measured. RESULTS: Actual pain experienced on day 1 was lower (p < .01) than anticipated pain and continued to decrease (p ≤ .01) for each of the 7 consecutive days. Anticipated and actual pain were positively correlated. Increasing age (p < .05), having sedation during the surgery (p < .05), and lower use of pain pills (p < .01) predicted lower pain experienced. Actual pain experienced was a predictor of pain pill use (p < .01). Greater nervousness (p < .01) prior to surgery was a predictor of greater anticipated pain. CONCLUSIONS: Patients anticipated more pain than they actually experienced. Sedation, age and number of pain pills used predicted pain experienced. This trial was registered with clinicaltrials.gov as NCT03064178.

Young donor white blood cell immunotherapy induces extensive tumor necrosis in advanced-stage solid tumors.

BACKGROUND: In the past decade, a variety of immunotherapy approaches focused predominantly on the adaptive immune system have shown unprecedented responses in patients with advanced-stage malignancies. However, studies in spontaneous regression/complete resistance (SR/CR) mice and humans have shown a novel innate cancer-killing activity mediated by granulocytes, which is completely transferable for prevention or therapy against established malignancies. METHODS: Three patients with advanced, relapsed or refractory solid tumors for which no standard therapy was available or was refused were enrolled into this ongoing combined phase I/II open label clinical trial testing the safety, dose tolerance, and possible antineoplastic efficacy of sequential infusions of HLA-mismatched non-irradiated allogeneic white cells (68-91% granulocytes) collected by leukapheresis from young, healthy donors (age 18-35) following mobilization with granulocyte colony stimulating factor (G-CSF) and dexamethasone. RESULTS: Besides fevers and flushing, no infusional toxicities were observed. All patients remained clinically stable following infusions with mild cytokine release syndrome and no evidence of transfusion-associated graft-versus-host disease, acute tumor lysis syndrome,or transfusion-associated acute lung injury. Pathological examination of all cases post-mortem revealed extensive tumor necrosis up to 80% in patients 1-2, 40-50% in patient 3, and leukocyte infiltration in all cases, which could not be attributed to disease progression. CONCLUSIONS: Allogeneic white cell immunotherapy (AWIT) from young, healthy donors is well tolerated with minimal side effects and shows antitumor activity against advanced-stage solid tumors. AWIT represents a novel, safe, and cost-effective immunotherapy that can be administered in an outpatient cancer clinic.