Association of oral frailty with medical expenditure in older Japanese adults: The study of late-stage older adults in Tottori (START Tottori).

OBJECTS: This study aimed to determine the association between annual medical expenses and oral frailty in later-stage older adults (aged ≥ 75 years). No studies have investigated the association between medical costs and oral frailty, which would elucidate the association between oral frailty and the deterioration of mental and overall physical function. MATERIALS AND METHODS: In this cross-sectional study, 2190 adults (860 men and 1330 women aged 75-94 years) covered by the Medical System for the Elderly and residing in Tottori Prefecture, Japan, between April 2016 and March 2019, were included. Participants were classified into three groups: healthy, pre-orally frail or orally frail, based on dental health screening findings. The medical and dental expenses over the years, number of days of consultations and comorbidities were obtained from the Japanese Health Insurance Claims Database. RESULTS: The number of days of medical and dental consultations and annual medical expenses for outpatient care differed among the three study groups. A significant association was observed between oral frailty and high annual expenses for outpatient medical and dental care. Oral frailty was associated with higher medical expenses in participants with poor masticatory function. Higher and lower dental expenses were associated with subjective poor masticatory function and subjective impairment of swallowing function respectively. CONCLUSION: Medical and dental expenses for orally frail older adults are high, indicating that oral frailty may be related to the occurrence and severity of diseases other than oral health issues. Future studies should examine the mechanism by which oral weakness affects physical and mental functions.

Hepatocellular Carcinoma Showing Tumor Shrinkage Due to an Abscopal Effect.

We herein report a 63-year-old man who presented with left lower jaw pain and was diagnosed with hepatocellular carcinoma with bone metastases post-examination. All tumors grew after immunotherapy with atezolizumab and bevacizumab, and his jaw pain worsened. After palliative radiation therapy, however, the tumors shrank markedly, with no recurrence seen after stopping immunotherapy. To our knowledge, this is the first case in which a radiotherapy- and immunotherapy-mediated abscopal effect facilitated tumor shrinkage and immunotherapy discontinuation.

Oral frailty, appetite and dietary variety in late-stage older adults: A cross-sectional study (the STudy of lAte-stage oldeR adulTs in Tottori; START Tottori).

AIM: Efforts to combat frailty and preserve good health in older adults have highlighted oral frailty as an early indicator of overall frailty. Individuals showing oral frailty are at an elevated risk of insufficient nutritional intake compared with those without oral frailty; however, underlying mechanisms remain poorly explored. In this cross-sectional study, we aimed to examine the link between oral frailty and undernutrition, especially regarding poor appetite and low dietary diversity. METHODS: The analysis included 2727 late-stage older adults (mean age 79.9 ± 4.3 years) who underwent dental checkups in a prefecture in Japan from 2016 to 2020. The examination involved a questionnaire survey (covering basic information, frailty screening index, appetite index: Simplified Nutritional Appetite Questionnaire; and dietary variety: Dietary Variety Score) and a measurement survey (including intraoral confirmation, oral diadochokinesis and masticatory efficiency test). Individuals with three or more indications of poor oral function, identified through oral function assessment, were defined as showing oral frailty. Binomial logistic regression and path analyses examined associations among oral frailty, Simplified Nutritional Appetite Questionnaire and Dietary Variety Score. RESULTS: Among those analyzed, 1208 (44.3%) participants were categorized into the oral frailty group. Binomial logistic regression analysis showed that Simplified Nutritional Appetite Questionnaire (odds ratio for oral frailty per 1-point increase 0.88, 95% confidence interval 0.84-0.93) and Dietary Variety Score (odds ratio 0.95, 95% confidence interval 0.92-0.98) were significantly associated with oral frailty. The path analysis showed individual associations between each examined factor. CONCLUSIONS: Oral frailty was associated with decreased appetite and dietary variety in late-stage older adults. Geriatr Gerontol Int 2024; 24: 626-633.

Platelet adhesion on commercially pure titanium plates in vitro I: effects of plasma components and involvement of the von Willebrand factor and fibronectin.

BACKGROUND: Platelet-rich plasma (PRP) is widely used in regenerative dentistry. Furthermore, it is often applied in the pretreatment of titanium implants to improve their surface bioaffinity and initial stability. However, effects of PRP application on implant surface at cellular and molecular levels remain poorly understood. Therefore, we examined platelet adhesion on commercially pure titanium (cp-Ti) plates, with a particular focus on fibrinogen (FGN), von Willebrand factor (vWF), and fibronectin (FN), in the presence or absence of plasma components. METHODS: Citrated blood samples were obtained from six healthy male volunteers, and pure-PRP (P-PRP) and pure platelet suspensions in phosphate-buffered saline (PBS) were prepared. Platelet adhesion on cp-Ti plate surface was evaluated by phalloidin staining and tetrazolium dye assay. Distribution of FGN, vWF, FN, albumin, CD62P, and CD63 was examined by immunocytochemical analysis. RESULTS: Platelets in PBS suspensions rapidly and time-dependently adhered to cp-Ti plate surface, but this adhesion was substantially disturbed by the presence of plasma components. FGN was most preferably adsorbed regardless of the presence or absence of plasma components, while vWF and FN showed greater accumulation on platelet adhesion area. CONCLUSIONS: Although FGN is rapidly and abundantly adsorbed on cp-Ti plate surface, vWF and FN function as major platelet adhesion molecules in citrated blood samples. After pretreatment with P-PRP, however, platelets adhered to cp-Ti much less efficiently. Therefore, P-PRP pretreatment might not directly contribute to surface functionalization, initial stabilization, and osseointegration of machined or similar types of implants.

Spectrophotometric determination of platelet counts in platelet-rich plasma.

BACKGROUND: Platelet-rich plasma (PRP) is widely used in regenerative dentistry and other medical fields. However, its effectiveness has often been questioned. For better evaluation, the quality of individual PRP preparations should be assured prior to use. We proposed a spectrophotometric method for determination of platelet counts and validated its applicability using two types of PRP preparations. METHODS: Blood samples were obtained from healthy male volunteers and pure PRP (P-PRP) and leukocytes-rich PRP (L-PRP) were prepared using the double-spin method. In serial dilutions, platelet counts in P-PRP and L-PRP were determined using an automated hematology analyzer and a compact spectrophotometer. For validation, P-PRP and L-PRP independently prepared by three well-trained operators were used for comparison of the calculated and measured platelet counts. RESULTS: In the two types of PRP samples evaluated, platelet counts were almost equal and greater amount of both white blood cells (WBCs) and red blood cells (RBCs) were included in L-PRP preparations. The calibration curve obtained from serially diluted P-PRP showed a strong correlation (R2 = 0.995), whereas that of L-PRP was relatively weaker (R2 = 0.975). In validation testing, the scatter plot of the calculated platelet counts versus the measured values showed a strong correlation in P-PRP (R2 = 0.671), whereas that of L-PRP showed a much weaker correlation (R2 = 0.0605). CONCLUSIONS: This method can precisely determine platelet counts in PRP preparations when the inclusion of WBCs or RBCs is minimized. Therefore, we recommend that clinicians use this method for quality assurance of individual PRP preparations.

A Study of the Maxillary Sinus Volume in Elderly Persons Using Japanese Cadavers.

In this paper, using full-body CT images of elderly and advanced elderly Japanese cadavers, we measure maxillary and other paranasal sinus volumes in order to examine the effects of age, sex, presence or absence of maxillary molars, and other factors on changes to maxillary sinus volume. The research subjects consisted of 77 of 95 cadavers donated to the Kanagawa Dental University between 2012 and 2014, which average age was 82.6 ± 10 years (33 were male, average age 79.3 ± 8.3 years, and 44 were female, average age 85.1 ± 11.7 years). Sinus volume was measured from full-body CT images on the horizontal plane and computed using the 3D volume rendering software. The average maxillary sinus volume was 31.3 ± 13.2 cm3 (average value ± one standard deviation; hereafter the same), with values of 32.9 ± 13.2 cm3 (6.7 cm3 ～ 55.7 cm3) for males and 29.6 ± 12.5 cm3 (5.5 cm3 ～ 52.9 cm3) for females. In this report, we studied the effects of aging, sex, and state of remaining molars on changes to paranasal sinus volume in the maxillary sinus. These results give additional information about maxillary sinus volume of Japanese oldest-old peoples.

Connexin 43 expression at an early stage in dog mandibles by ß-TCP.

ß-TCP was implanted into bone defects of dog mandibles, and gene expression profiles were examined using DNA microarray. An implant drill was used to make bone defects, and then ß-TCP was filled into bone defects. All specimens were taken out, total RNA was isolated, and levels were analyzed using Affymetrix GeneChip. Higher mRNA levels of connexin 43 (Cx43) and Cx45 were observed in ß-TCP-implanted samples compared with controls. The enhancement of Cx43 and Cx45 by ß-TCP was confirmed by RT-PCR and real-time RT-PCR. Since Cx43 is known to express in bone-forming regions and is involved in osteogenesis through gap junctional intercellular bone-cell communication (GJIB), immunohistochemical staining was also examined and demonstrated Cx43 protein expression was increased in ß-TCP-implanted bone. Cx43 plays a role in osteogenesis through GJIB; therefore, the stimulation of Cx43 expression by ß-TCP might be a mechanism of accelerating wound healing and bone formation.