Sugar-sweetened beverage consumption and periodontitis among adults: A population-based cross-sectional study.

AIM: Investigating the association between sugar-sweetened beverages (SSBs) and periodontitis and whether the awareness of diabetes modifies this relationship. MATERIALS AND METHODS: Cross-sectional analysis was conducted using the National Health and Nutrition Examination Survey (NHANES III) data involving US adults aged 30-50. Periodontitis was classified according to the Centers for Disease Control and Prevention and American Academy of Periodontology (CDC-AAP), and SSB consumption as dichotomous (<5 or ≥5, <7 or ≥7 and <14 or ≥14 times/week), ordinal and continuous variables. Confounders included family income poverty ratio, education, race/ethnicity, sex, age, food energy intake, smoking and alcohol. Odds ratios (ORs) were obtained by logistic regressions using inverse probability weighting. Effect modification analysis was performed considering self-reported diabetes. RESULTS: Among 4473 cases analysed, 198 self-reported diabetes. SSBs were associated with periodontitis when individuals consumed ≥5 (OR 1.64; 95% confidence interval [CI] = 1.30-2.06), ≥7 (OR 1.92; 95% CI = 1.50-2.46) and ≥14 (OR 2.19; 95% CI = 1.50-3.18) times/week. The combined effect of consuming SSBs (≥5 and ≥14 times/week) and self-reported diabetes had less impact than the cumulative effect. CONCLUSIONS: SSB consumption was associated with higher odds of periodontitis, and the estimates were reduced among those with awareness of diabetes.

Longitudinal association between periodontal condition and glycaemic status in middle-aged adults: A cross-lagged panel analysis.

AIM: To investigate the existence of a bidirectional temporal relationship between periodontal condition and glycaemic status. MATERIALS AND METHODS: This longitudinal study included 2198 participants with mean age 43.4 ± 7.7 years, who underwent dental examinations in Yokohama, Japan, at two time points, 2003-2004 and 2008-2009, at an interval of 5 years. Periodontal condition was assessed by the mean value of probing pocket depth (PPD) and clinical attachment level (CAL). Glycaemic status was assessed by fasting glucose and glycated haemoglobin (HbA1c). RESULTS: The cross-lagged panel models showed the effect of HbA1c at baseline on mean PPD at follow-up (ß = 0.044, p = .039). There was a marginal effect of fasting glucose on the mean PPD (ß = 0.037, p = .059). It was similar to the effect of fasting glucose or HbAlc on mean CAL. However, in the opposite direction, no effect of mean PPD or CAL at baseline on fasting glucose or HbAlc at follow-up was identified. CONCLUSIONS: This study demonstrated a unidirectional relationship between glycaemic status and periodontal condition. The study population, however, had mostly mild periodontitis. Future studies are needed to investigate the effect of periodontal condition on glycaemic status in patients with severe periodontitis.

Effects of chronic fluorosis on the brain.

This article reviews the effects of chronic fluorosis on the brain and possible mechanisms. We used PubMed, Medline and Cochraine databases to collect data on fluorosis, brain injury, and pathogenesis. A large number of in vivo and in vitro studies and epidemiological investigations have found that chronic fluorosis can cause brain damage, resulting in abnormal brain structure and brain function.Chronic fluorosis not only causes a decline in concentration, learning, and memory, but also has mental symptoms such as anxiety, tension, and depression. Several possible mechanisms that have been proposed: the oxidative stress and inflammation theory, neural cell apoptosis theory, neurotransmitter imbalance theory, as well as the doctrine of the interaction of fluorine with other elements. However, the specific mechanism of chronic fluorosis on brain damage is still unclear. Thus, a better understanding of the mechanisms via which chronic fluorosis causes brain damage is of great significance to protect the physical and mental health of people in developing countries, especially those living in the endemic areas of fluorosis. In brief, further investigation concerning the influence of fluoride on the brain should be conducted as the neural damage induced by it may bring about a huge problem in public health, especially considering growing environmental pollution.

Prevalence and risk factors of erosive tooth wear among young adults in the Singapore military.

OBJECTIVES: Erosive tooth wear (ETW) is defined as the irreversible chemo-mechanical loss of dental hard tissues without plaque or bacteria and has been a growing phenomenon in the general population worldwide. The aim of this study was to determine the prevalence of ETW and the associated risk factors among young military personnel in Singapore. MATERIALS AND METHODS: This cross-sectional study consisted of a questionnaire and clinical examination of military personnel between 18 and 25 years. The questionnaire collected information on demographics, medical and dental history, lifestyle and dietary habits. Tooth wear was clinically evaluated using the Basic Erosive Wear Examination (BEWE) index. The participants were profiled into four risk categories (none, low, moderate, severe) based on the sum score. Multivariable logistic regression analysis was performed to determine the risk factors associated with the presence of ETW. RESULTS: Out of 1296 participants evaluated, 21.8% of them had ETW. The anterior sextants were more affected by erosion than posterior sextants for both arches. The risk factors significantly associated with ETW were GERD (OR = 2.83, p = 0.041), presence of self-reported TMD symptoms (OR = 2.51, p < 0.001), acidic food (OR = 2.03, p < 0.001) and drinks (OR = 3.07, p < 0.001), high caries risk (OR = 4.59, p < 0.001) and toothbrush stiffness (OR = 4.67, p < 0.001). CONCLUSION: ETW is prevalent among the young military population, with over half of the population at a risk of ETW. Gastric reflux disease, TMD, acidic diet, dental caries susceptibility and the use of stiff toothbrushes were identified as significant risk factors. CLINICAL RELEVANCE: A large proportion of young military personnel exhibited mild to moderate risk of ETW. Dental professionals can identify risk-susceptible individuals at a young age and educated them with preventive measures and dietary interventions to prevent the progression of the condition.

Isobaric tags for relative and absolute quantification (iTRAQ)-based quantitative analysis of the salivary proteome during healthy pregnancy and pregnancy gingivitis.

AIM: The present study aimed to investigate the salivary proteome profiles of pregnant women with gingivitis (PG) or without gingivitis (HP) and non-pregnant healthy controls (HC) by employing iTRAQ-based proteomics. MATERIALS AND METHODS: Saliva samples were collected from 30 Chinese women comprising 10 subjects in each of the three groups (PG, HP, and HC). The samples were subjected to iTRAQ-based proteomics analysis, and ELISA was performed to validate the results. The subsequent observations were validated in a cohort of 48 subjects. RESULTS: Pathways associated with neutrophil-mediated immune response and antioxidant defence mechanism were significantly higher in PG than HC. The abundance of salivary cystatins (S, SA, and SN) and antimicrobials were significantly decreased in PG and HP, while cystatin C and D were additionally decreased in PG. Cystatin C was mapped to all the major catabolic pathways and was the most re-wired protein in pregnancy gingivitis. Further validation demonstrated cystatin C to be significantly lower in PG than HC. CONCLUSIONS: While the decrease in levels of salivary cystatins and antimicrobial proteins may predispose healthy pregnant women to pregnancy gingivitis, it may cause persistence of inflammation in pregnant women with gingivitis.

The cognitive impairment and risk factors of the older people living in high fluorosis areas: DKK1 need attention.

OBJECTIVE: To evaluate cognitive impairment and risk factors of elders in high fluoride drinking water areas and investigate whether DKK1 is involved in this disorder. METHODS: MoCA-B and AD-8 were used to measure the cognitive functions of 272 and 172 subjects over the age of 60 came from the high and normal fluoride drinking water areas respectively, general information and peripheral blood were collected, the level of SOD, GSH and MDA were measured, mRNA level of DKK1, the concentration of blood fluoride and the polymorphism of APOE were tested. RESULTS: The blood fluoride concentration, mRNA level of DKK1 and ratio of abnormal cognitive function of subjects in high fluorine drinking water areas were higher than those in normal areas. The level of SOD of subjects in high fluorine drinking water was low compared with those in normal areas. The level of MDA and GSH had no difference between the two crowds in different fluorine drinking water areas. There were differences in cigarette smoking, education, dental status, hypertension, hyperlipidaemia and APOE results between the two crowds in different fluorine drinking water areas. The mRNA level of DKK1 and the level of cognitive function showed a positive correlation and DKK1 was one of five risk factors involved in cognitive impairment of older people living in high fluorosis areas. CONCLUSIONS: The cognitive functions could be impaired in the older people living in high fluoride drinking water areas, and DKK1 may as a potential intervention point of this brain damage process need attention.

EGb-761 Attenuates the Anti-proliferative Activity of Fluoride via DDK1 in PC-12 Cells.

EGb-761 is commonly used as a treatment for ischemic brain injury, neurodegenerative diseases and some types of tumors (Christen and Maixent, in Cell Mol Biol 48(6):601-611, 2002). However, it is unclear whether EGb-761 affects the proliferation of cells exposed to fluoride. In this study, the proliferation and apoptosis of PC-12 cells exposed to fluoride were investigated and EGb-761 was used to protect PC-12 cells against the effects of fluoride. We found that the canonical Wnt signaling pathway was involved in the anti-proliferation of PC-12 cells exposed to fluoride. Furthermore, the results also showed that EGb-761 could attenuate the anti-proliferative activity of fluoride via DDK1 in PC-12 cells. This study may provide a new method for protecting against the inhibition of cell proliferation induced by fluoride.

Longevity of acrylic and cobalt-chromium removable partial dentures-A ten-year retrospective survival analysis of 1246 denture-wearing patients.

OBJECTIVES: to assess the survival rates of removable partial dentures (RPDs) and identify factors impacting their longevity. METHODS: electronic health records were retrieved of patients aged ≥18 who received RPDs between 2010 - 2021 with a follow-up of ≥ three months. Data extracted included demographics, medical history, dental charting, periodontal screening and recording scores, prostheses details and related interventions, including new dentures/denture remakes, and maintenance. Multivariate Mixed-Effect Cox regression was performed to identify potential RPD survival risk factors. Reduced model selection was reached using a backward step-down by comparing the performance of these multivariable models using the ANOVA test. RESULTS: 1893 RPDs from 1246 patients were included, with a median follow-up of 21.8 months (range from 3 to 131.3 months). Three hundred and twelve patients received a maxillary RPD, 460 received a mandibular RPD, and the remaining 474 patients received both maxillary and mandibular RPDs. Metal-based RPDs had a median survival of 73 months (95%CI: 70 - 82) versus 45 months (95% CI: 37-67) for acrylic ones. Multivariable mixed effects Cox model showed that the lifespans of RPDs were longer amongst patients receiving more maintenance care within three months [Hazards Ratio (HR)=0.89 (0.83, 0.96)] and after three months [HR=0.53 (0.46, 0.61)] of denture delivery, patients wearing both maxillary and mandibular RPDs [HR=0.67 (0.52, 0.87)], and patients receiving metal-based RPDs [HR=0.31 (0.23, 0.42)]. CONCLUSIONS: Metal-based dentures, dual arch restoration, and increased maintenance positively impact the survival of RPDs. CLINICAL SIGNIFICANCE: Adapting consent and warranty practices is advised to reflect RPD performance variations.

Chewing Disability Is Associated With Cognitive Impairment Among Older Adults: A Population-Based Cohort Study.

BACKGROUND: Chewing disability is associated with impaired quality of life, potentially leading to depression, and cognitive impairment. Although the chewing-ability-cognition relationship has been explored, examining whether depression mediates this relationship remains unclear. We investigated the association between chewing disability and cognitive impairment development and a potential mediation via depression among older persons. METHODS: Older persons without cognitive impairment at baseline (n = 973) from the 3 waves of the Panel on Health and Ageing of Singaporean Elderly were investigated. The outcome was incident cognitive impairment by the end of the study, while the exposure was chewing disability over the study period. Time-varying depression was the mediator. Time-fixed confounders included sex, ethnicity, education, marital status, living arrangement, and housing type, and time-varying confounders included age, smoking, cardiovascular diseases, diabetes, number of teeth, and denture wearing. We used marginal structural modeling to evaluate the effect of chewing disability on cognitive impairment development. RESULTS: After 6 years, 11% developed cognitive impairment, and chewing disability was reported by 33%. Chewing disability was associated with higher odds of developing cognitive impairment (OR 1.43, 95% CI: 1.09, 1.87), of which 85.3% was explained by the controlled direct effect of chewing disability, whereas the remaining 14.7% could be eliminated if there was no depression. CONCLUSIONS: Our findings indicate an association between chewing disability and cognitive impairment, while the role of depression could not be fully elucidated. Oral health should be incorporated as part of older persons' care for its potential to assess the risk for other systemic conditions.

Development of a nomogram for identifying periodontitis cases in Denmark.

Although self-reported health outcomes are of importance, attempts to validate a clinical applicable instrument (e.g., nomogram) combining sociodemographic and self-reported information on periodontitis have yet to be performed to identify periodontitis cases. Clinical and self-reported periodontitis, along with sociodemographic data, were collected from 197 adults. Akaike information criterion models were developed to identify periodontitis, and nomograms developed based on its regression coefficients. The discriminatory capability was evaluated by receiver-operating characteristic curves. Decision curve analysis was performed. Smoking [OR 3.69 (95%CI 1.89, 7.21)], poor/fair self-rated oral health [OR 6.62 (95%CI 3.23, 13.56)], previous periodontal treatment [OR 9.47 (95%CI 4.02, 22.25)], and tooth loss [OR 4.96 (95%CI 2.47, 9.97)], determined higher probability of having "Moderate/Severe Periodontitis". Age [OR 1.08 (95%CI 1.05, 1.12)], low educational level [OR 1.65 (95%CI 1.34, 2.23)], poor/fair self-rated oral health [OR 3.57 (95%CI 1.82, 6.99)], and previous periodontal treatment [OR 6.66 (95%CI 2.83, 15.68)] determined higher probability for "Any Periodontitis". Both nomograms showed excellent discriminatory capability (AUC of 0.83 (95%CI 0.75, 0.91) and 0.81 (95% CI 0.74, 0.88), good calibration, and slight overestimation of high risk and underestimation of low risk. Hence, our nomograms could help identify periodontitis among adults in Denmark.

Prevalence and experience of dental caries among Singaporean schoolchildren: A time-trend analysis from 2007 to 2019.

OBJECTIVES: This study aimed to describe caries prevalence and experience trends of permanent teeth among Singapore schoolchildren between 2007 and 2019. METHODS: Anonymized records of all 6-year-old Primary 1 (P1), 11-year-old Primary 6 (P6) and 14-year-old Secondary 3 (S3) before the start of each school year were extracted from the Integrated Dental Electronic Assessment System (IDEAS) by school level, ethnicity and sex. Prais-Winsten regression was used to assess trends of mean decayed, missing and filled teeth (DMFT) and caries prevalence (% DMFT > 0) among the schoolchildren by school level, with reported Average Annual Percentage Change (AAPC) together with respective 95% confidence interval (CI). RESULTS: In total, 519 471 P1, 566 573 P6 and 548 138 S3 were included during the above period, and the majority were comprised of Chinese children (P1: 67.2%, P6: 68.8% and S3: 71.0%, respectively). Overall, the prevalence of caries dropped from 6.9% in 2007 to 3.5% in 2019 among P1, from 34.5% in 2009 to 20.3% in 2019 among P6 and from 41.5% in 2007 to 33.5% in 2019 among S3 schoolchildren. The mean DMFT reduced from 0.11 to 0.05 among P1, 0.72 to 0.35 among P6 and 1.05 to 0.76 among S3 schoolchildren during the same period. Caries prevalence and mean DMFT were consistently higher among girls. On average, caries prevalence decreased 5% per year in P1 (AAPC -5.0 [95% CI: -6.1, -3.9]) and P6 (AAPC -4.9 [95% CI: -5.7, -4.1]) and 2% among S3 (AAPC -2.0 [95% CI: -3.5, -0.4]) schoolchildren. Caries prevalence decreased approximately 4% ~ 5% annually among P1 and P6 schoolchildren regardless of ethnicity. The average decrease in caries prevalence was lower (about 2%) among all ethnicities at S3 school level. CONCLUSION: Dental caries in permanent dentition of Singaporean schoolchildren had decreased from 2007 to 2019. However, the decrease observed among primary school students was more than double that among secondary schoolchildren.

Breastfeeding Protects from Overjet in Adolescence by Reducing Pacifier Use: A Birth Cohort Study.

Increased dental overjet in adolescence is a clinically relevant outcome associated with the complexity and high cost of treatment, indicating the need for prevention strategies. We investigated the long-term impact of breastfeeding and pacifier use on increased overjet (IOVJ) in permanent dentition. A prospective cohort nested in a randomized controlled trial was conducted from birth to 12 years of age (n = 214). Breastfeeding and pacifier use were recorded monthly until 12 months. Overjet was assessed at age 12 years. We employed a causal mediation analysis using parametric regression models assuming no interaction between breastfeeding and pacifier usage. We found a total protective effect of breastfeeding on IOVJ (OR 0.49; 95% CI 0.28-0.96), where 63.1% were mediated by pacifier use (OR 0.61; 95% CI 0.44-0.87). Breastfeeding directly decreased the odds of IOVJ by 20%; however, the confidence interval included the null estimate (OR 0.81; 95% CI 0.41-1.60). In conclusion, breastfeeding protects by half of the IOVJ in adolescence through reducing pacifier use. Oral and general health professionals should collaborate to support WHO breastfeeding guidelines during individual patient counseling. Guidelines for practice, policy or public information require messages that include a common risk approach to oral and general health.

Who to Be Treated: Nomogram Using Self-Reported Periodontal Screening Instrument among English-Speaking Adults in Multi-Ethnic Singapore.

Periodontal disease is a major public health problem. This study aimed to develop a nomogram using a self-reported periodontitis screening instrument in predicting severe periodontitis (SP), defined by the World Workshop on Classification of Periodontal and Peri-Implant Diseases and Conditions, and evaluate its utility in clinical setting. An Akaike information criterion selected multivariable model was developed to predict SP using a self-reported questionnaire, with a nomogram developed based on its regression coefficients. Discriminatory capability was evaluated by Receiver-operating characteristic curve. Ability to predict SP of individual patients was evaluated with bootstrapping. Decision curve analysis (DCA) was performed to evaluate its potential clinical utility by evaluating clinical net benefit at different thresholds. 58.1% of 155 participants were classified with SP. Older males without tertiary education, with 'loose teeth', 'bone loss' and 'mouth rinse use' had higher SP risk. The nomogram showed excellent discriminatory capability with Area under Curve of 0.83 (95% CI = (0.76, 0.89)), good calibration (intercept = 0.026) and slight overestimation of high risk and underestimation of low risk (slope = 0.834). DCA showed consistent clinical net benefit across the range of thresholds relative to assumption of 'no patient' or 'all patient' with SP. Our nomogram using a self-reported periodontitis instrument is useful in SP screening in English-speaking Singaporean adults.

Biofunctionalized Nanofibrous Bilayer Scaffolds for Enhancing Cell Adhesion, Proliferation and Osteogenesis.

A simple and efficient method for fabricating functionalized multilayered nanofibrous scaffolds has been developed by combining electrospinning and thermally induced phase separation (TIPS) techniques. In this investigation, functionalized bilayer scaffolds were constructed using this method for bone tissue engineering, which consisted of a nanofibrous poly(lactic acid-co-glycolic acid) (PLGA) membrane as the base and a nanofibrous chitosan (CS) or gelatin (Gel) mesh as the surface layer, with the PLGA nanofibers having a biomimetic polydopamine (PDA) coating. It was shown that the PDA coating strongly bonded TIPS-formed CS or Gel networks onto PDA-coated electrospun PLGA membranes. The nanofibrous PLGA membrane provided adequate mechanical support for the whole structure, and the nanofibrous CS or Gel networks enhanced cell growth and maturation. The bioinspired surface modification of PLGA scaffolds through PDA coating could not only provide strong adhesion between the two scaffold layers but also improve biological properties of scaffolds. It was demonstrated that functionalized bilayer scaffolds could promote cell adhesion, spreading and proliferation of mouse preosteoblastic MC3T3-E1 cells and rat bone-marrow-derived stromal cells (rBMSCs). Furthermore, immunofluorescence staining and calcium deposition studies revealed that functionalized bilayer scaffolds could enhance osteogenic differentiation of MC3T3-E1 cells and rBMSCs in comparison with simple electrospun PLGA scaffolds. The functionalized bilayer scaffolds are promising structures for bone tissue engineering.

Tooth wear and socioeconomic status in childhood and adulthood: Findings from a systematic review and meta-analysis of observational studies.

OBJECTIVES: To evaluate the association and level of evidence between socioeconomic status (SES) and tooth wear (TW) in children, adolescents, and adults. DATA: Eligibility criteria comprised population-based observational studies assessing the association between SES and TW in permanent dentition of adolescents and adults. Interventional and descriptive studies or those without an internal comparison between exposed and nonexposed groups were excluded. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied where applicable. Risk of bias (RoB) was assessed using the Newcastle-Ottawa scale. Meta-analyses were conducted to estimate the pooled effect measures. Q-statistic, I2statistic, subgroup and sensitivity analyses assessed study heterogeneity. SOURCES: PubMed/Medline, Embase, Scopus, Web of Science, LILACS, SciELO, Cochrane Library, and Google Scholar databases were searched for articles published in English between 1st January 1980 and 31st March 2021. RESULTS: Sixty-five studies were included, involving 63,893 participants in over 30 countries. A positive association was found between TW and education (OR=1.25 [0.96; 1.62]), family income (OR=1.18 [0.91; 1.53]), and private school (OR= 1.24 [0.90; 1.72]) among adolescents. Higher educated adults had a lower risk for TW (OR=0.70 [0.52; 0.93]). Most included studies had a moderate RoB. Limitations relating to population representation and assessment methodologies were identified in the included studies. CONCLUSIONS: SES was associated with TW with its direction depending on the individuals' age. The overall quality of evidence was moderate. CLINICAL SIGNIFICANC: SES should be included as part of the routine screening and risk assessment for tooth wear.

Deferoxamine immobilized poly(D,L-lactide) membrane via polydopamine adhesive coating: The influence on mouse embryo osteoblast precursor cells and human umbilical vein endothelial cells.

Osteogenesis and angiogenesis play the prominent role in the bone regeneration. In this study, deferoxamine (DFO), an induced agent for osteogenesis and angiogenesis, was modified onto the surface of poly(D,L-lactide) (PDLLA) membrane via a facile and convenient approach based on the self-polymerization of dopamine (DOPA). The surface composition, morphology, hydrophilicity and surface energy of the original and modified PDLLA membranes were characterized by Fourier transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), scanning electronic microscopy (SEM), atomic force microscopy (AFM) and contact angle measurement. The surface roughness and hydrophilicity of the PDLLA membrane were obviously increased by introducing either the single polydopamine (PDOPA) or the dual layers of PDOPA and DFO. In vitro cells culture experiments indicated that both the PDLLA/PDOPA and PDLLA/PDOPA-DFO composite membranes were more beneficial to the attachment, proliferation and spreading of MC3T3-E1 cells and HUVECs compared to the original PDLLA membrane. The PDLLA/PDOPA-DFO membrane was supportive for the proliferation of both MC3T3-E1 cells and HUVECs, and especially for HUVECs. The results suggested that the as-prepared PDLLA/PDOPA-DFO composite can be expected to be used as a promising bone regenerative material with promoted angiogenesis.

A descriptive analysis of remnant activity during (90)Y resin microspheres radioembolization of hepatic tumors: technical factors and dosimetric implications.

OBJECTIVE: Activity planning for (90)Y radioembolization aims to maximize the effect of the treatment while keeping toxicity acceptably low. Our aim was to describe the amount of residual activity in post-treatment v-vials and tubing and analyze the possible factors affecting it (total activity administered, number of split activity injection(s), previous treatments, administration artery and microcatheter size), as these may influence dosimetric planning and treatment. METHODS: This was a retrospective review using case records of patients who received (90)Y-radioembolization for hepatic tumors at a single tertiary center. From August 2013 to September 2015, seventy-seven out of one hundred and fifty patients who received radioembolization with (90)Y resin microspheres due to inoperable Hepatocellular Carcinoma (HCC) or liver metastases were included. The rest were mainly excluded due to incomplete data sets. The number of split activities (injections) for the radioembolization could be: one single injection, two or three. The remnant activity in post-treatment v-vials and tubing were measured for every patient. The administration arteries evaluated were: proper hepatic artery (PHA), right hepatic artery (RHA), middle hepatic artery (MHA), left hepatic artery (LHA) and small caliber branch arteries. The sizes of the microcatheters (2.2 or 2.7 Fr) used to administer the dose were also evaluated. RESULTS: In total, 77 out of 150 patients were included in the final analysis. There were 59 men of median age 64.0 years old. The total median dose loss was 0.10 GBq. The total dose loss increased 0.244 GBq [95 % CI = (0.169, 0.318)] when three split activities were given compared to single activity injection. Activity loss for each injection increased 0.0297 GBq [95 % CI = (0.0151, 0.0443)] for every 1.0 GBq increase of split activity injection. There were no significant statistical differences in the rest of patient characteristics. CONCLUSIONS: There is significant loss of activity observed during radioembolization, which can have a major dosimetric impact. The total administered activity and the number of split injections during radioembolization are the main influencing factors. Further prospective studies as well as measures of clinical outcome are warranted.