Diabetes and dental caries in US adults: an analysis of data from the National Health and Nutrition Examination Survey, 2011-2018.

OBJECTIVES: To determine the relationship between diabetes and dental caries among US adults participating in the 2011-2018 National Health and Nutrition Examination Survey (NHANES). BASIC RESEARCH DESIGN: The NHANES was a cross-sectional study including clinical assessments, laboratory analysis, and interviews. The sample included 16,635 participants aged 20 years and older that represent 187,596,215 individuals in the US in a probability weighted sample. Outcome variables included overall total caries score (or number of decayed, missing, filled permanent teeth - DMFT index) and the presence of caries. Bivariate analysis, Poisson regression for total caries score, logistic regression for the presence of caries were used for analysis. RESULTS: Controlling for covariates, multiple Poisson regression revealed that total DMFT scores were associated with diabetes status (adjusted relative risk ratio (RR)controlled diabetes = 1.13, RRuncontrolled diabetes = 1.18; p⟨0.001), no college education, female sex, white race, elderly (≥ 65 years), cigarette smoking, obesity, yearly dental visits, seeing a dentist only for treatment. Similarly, multiple logistic regression shows that the odds of adults with diabetes having dental caries were higher than among those without diabetes (adjusted risk ratio (OR)controlled diabetes = 1.84, ORuncontrolled diabetes = 1.87; p⟨0.05). CONCLUSIONS: Diabetes was associated with a higher caries score and a greater risk for dental caries among US adults.

Links between oral health-related quality of life in US adults and type 2 diabetes: structural equation modeling analysis.

OBJECTIVES: To analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services on oral health-related quality of life (OHRQoL) in US adults. BASIC RESEARCH DESIGN: The sample included 2,945 participants (aged ≥ 20) selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented 124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM). RESULTS: SEM supported the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (ß=0.49, p⟨0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (ßdirect=0.30, ßindirect=0.09, p⟨ 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (ß=0.46, p⟨0.001). Need, in turn, predicted OHRQoL (ß=0.19, p⟨0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by need, personal health practices including use of services, and OHRQoL, respectively. CONCLUSIONS: The results confirmed T2DM predicted need, which in sequence had direct and indirect effects on OHRQoL.

Clinical activity of programmed cell death 1 (PD-1) blockade in never, light, and heavy smokers with non-small-cell lung cancer and PD-L1 expression ≥50.

BACKGROUND: Immune checkpoint inhibitors (ICIs) are standard therapies for patients with advanced non-small-cell lung cancer (NSCLC) and a programmed death-ligand 1 (PD-L1) tumor proportion score (TPS) ≥50%. Tumor mutation burden (TMB) also predicts response to ICIs but is often not available in real time for decision making in the first-line setting. Smoking exposure can be a proxy for TMB in NSCLC. The impact of smoking status on efficacy of PD-1 blockade in NSCLC patients with PD-L1 TPS ≥50% has not been well defined. PATIENTS AND METHODS: To investigate the relationship between smoking and activity of ICIs in NSCLC, we retrospectively studied 315 patients with NSCLC and PD-L1 TPS ≥50% at five USA academic medical centers. Objective response rates (ORRs), progression-free survival (PFS), and duration of response (DOR) were compared between never (<100 lifetime cigarettes), light (≤10 pack-years), and heavy (>10 pack-years) smokers. A subset of patients underwent next-generation sequencing to estimate TMB. RESULTS: We identified 36 (11%) never, 42 (13%) light, and 237 (75%) heavy smokers with NSCLC and PD-L1 TPS ≥50% treated with ICIs. Objective responses were observed in 27%, 40%, and 40% of never, light, and heavy smokers, respectively (P = 0.180 never versus heavy; P = 1.000 light versus heavy). Median PFS and median DOR were numerically shorter in never and light smokers compared with heavy smokers (PFS 3.0 versus 4.0 versus 5.4 months; median DOR 6.9 versus 10.8 versus 17.8 months), but were not statistically different [PFS: hazard ratio (HR) 1.37, P = 0.135 and HR 1.24, P = 0.272; DOR: HR 1.92, P = 0.217 and HR 1.79, P = 0.141]. CONCLUSIONS: PD-(L)1 inhibitors are associated with antitumor activity in NSCLC with PD-L1 TPS ≥50% regardless of smoking status. Nevertheless, there is a signal of potentially decreased durability among never and light smokers that should be further evaluated. Distinct immunobiologic features may affect initial response versus durability of antitumor immunity to programmed cell death 1 (PD-1) blockade.

Presentations and outcomes of interstitial lung disease and the anti-Ro52 autoantibody.

BACKGROUND: Distinct clinical presentations of interstitial lung disease (ILD) with the myositis-specific antibodies, including anti-synthetase antibodies, are well-recognized. However, the association between ILD and the myositis-associated antibodies, including anti-Ro52, is less established. Our objectives were to compare presenting phenotypes of patients with anti-Ro52 alone versus in combination with myositis-specific autoantibodies and to identify predictors of disease progression or death. METHODS: We performed a retrospective cohort study of 73 adults with ILD and a positive anti-Ro52 antibody. We report clinical features, treatment, and outcomes. RESULTS: The majority of patients with ILD and anti-Ro52 had no established connective tissue disease (78%), and one-third had no rheumatologic symptoms. Thirteen patients (17.8%) required ICU admission for respiratory failure, with 84.6% all-cause mortality. Of the 73 subjects, 85.7% had a negative SS-A, and 49.3% met criteria for idiopathic pneumonia with autoimmune features (IPAF). The 50 patients with anti-Ro52 alone were indistinguishable from patients with anti-Ro52 plus a myositis-specific autoantibody. ICU admission was associated with poor outcomes (HR 12.97, 95% CI 5.07-34.0, p < 0.0001), whereas rheumatologic symptoms or ANA > = 1:320 were associated with better outcomes (HR 0.4, 95% CI 0.16-0.97, p = 0.04, and HR 0.29, 95% CI 0.09-0.81, p = 0.03, respectively). CONCLUSIONS: Presentations of ILD with the anti-Ro52 antibody are heterogeneous, and outcomes are similar when compared to anti-Ro52 plus myositis-specific antibodies. Testing for anti-Ro52 may help to phenotype unclassifiable ILD patients, particularly as part of the serologic criteria for IPAF. Further research is needed to investigate treatment of ILD in the setting of anti-Ro52 positivity.

Efficacy of Toric Contact Lenses in Fitting and Patient-Reported Outcomes in Contact Lens Wearers.

OBJECTIVES: To assess whether patient-reported measures are improved with soft toric contact lenses (TCLs) compared with soft spherical contact lenses (SCLs) and whether clinical time needed to fit TCL is greater than SCL. METHODS: Habitual contact lens wearers with vertexed spherical refraction +4.00 to +0.25 D or -0.50 to -9.00 D and cylinder -0.75 to -1.75 DC were randomly assigned to be binocularly fitted into a TCL or SCL, and masked to treatment assignment. Time to successful fit was recorded. After 5 days, the National Eye Institute Refractive Error Quality of Life Instrument (NEI-RQL-42) and modified Convergence Insufficiency Symptom Survey (CISS) were completed. After washout, subjects were fit into the alternative lens design (TCL or SCL). Outcomes were evaluated using linear mixed models for the time to fit and CISS score, generalized linear model for the successful fit, and Wilcoxon tests for the NEI-RQL-42. RESULTS: Sixty subjects (71.7% women, mean age [±SD] = 27.5±5.0 years) completed the study. The mean time to fit the TCL was 10.2±4.3 and 9.0±6.5 min for the SCL (least square [LS] mean difference (TCL-SCL)=1.2, P=0.22). Toric contact lens scored better than SCL in global NEI-RQL-42 score (P=0.006) and the clarity of vision (P=0.006) and satisfaction with correction subscales (P=0.006). CISS showed a 15% reduction in symptoms (LS mean difference [TCL-SCL]=-2.20, P=0.02). CONCLUSION: TCLs are a good option when trying to improve the vision of patients with low-to-moderate astigmatism given the subjective improvements in outcomes.

Unusual behavior in magnesium-copper cluster matter produced by helium droplet mediated deposition.

We demonstrate the ability to produce core-shell nanoclusters of materials that typically undergo intermetallic reactions using helium droplet mediated deposition. Composite structures of magnesium and copper were produced by sequential condensation of metal vapors inside the 0.4 K helium droplet baths and then gently deposited onto a substrate for analysis. Upon deposition, the individual clusters, with diameters ∼5 nm, form a cluster material which was subsequently characterized using scanning and transmission electron microscopies. Results of this analysis reveal the following about the deposited cluster material: it is in the un-alloyed chemical state, it maintains a stable core-shell 5 nm structure at sub-monolayer quantities, and it aggregates into unreacted structures of ∼75 nm during further deposition. Surprisingly, high angle annular dark field scanning transmission electron microscopy images revealed that the copper appears to displace the magnesium at the core of the composite cluster despite magnesium being the initially condensed species within the droplet. This phenomenon was studied further using preliminary density functional theory which revealed that copper atoms, when added sequentially to magnesium clusters, penetrate into the magnesium cores.

Synthesized soliton crystals.

Dissipative Kerr soliton (DKS) featuring broadband coherent frequency comb with compact size and low power consumption, provides an unparalleled tool for nonlinear physics investigation and precise measurement applications. However, the complex nonlinear dynamics generally leads to stochastic soliton formation process and makes it highly challenging to manipulate soliton number and temporal distribution in the microcavity. Here, synthesized and reconfigurable soliton crystals (SCs) are demonstrated by constructing a periodic intra-cavity potential field, which allows deterministic SCs synthesis with soliton numbers from 1 to 32 in a monolithic integrated microcavity. The ordered temporal distribution coherently enhanced the soliton crystal comb lines power up to 3 orders of magnitude in comparison to the single-soliton state. The interaction between the traveling potential field and the soliton crystals creates periodic forces on soliton and results in forced soliton oscillation. Our work paves the way to effectively manipulate cavity solitons. The demonstrated synthesized SCs offer reconfigurable temporal and spectral profiles, which provide compelling advantages for practical applications such as photonic radar, satellite communication and radio-frequency filter.

Severity of Chest Imaging is Correlated with Risk of Acute Neuroimaging Findings among Patients with COVID-19.

BACKGROUND AND PURPOSE: Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. MATERIALS AND METHODS: This retrospective study included all patients with COVID-19 who received care at our hospital between March 3, 2020, and May 6, 2020, and underwent chest imaging within 10 days of neuroimaging. Chest radiographs were assessed using a previously validated automated neural network algorithm for COVID-19 (Pulmonary X-ray Severity score). Chest CTs were graded using a Chest CT Severity scoring system based on involvement of each lobe. Associations between chest imaging severity scores and acute neuroimaging findings were assessed using multivariable logistic regression. RESULTS: Twenty-four of 93 patients (26%) included in the study had positive acute neuroimaging findings, including intracranial hemorrhage (n = 7), infarction (n = 7), leukoencephalopathy (n = 6), or a combination of findings (n = 4). The average length of hospitalization, prevalence of intensive care unit admission, and proportion of patients requiring intubation were significantly greater in patients with acute neuroimaging findings than in patients without them (P < .05 for all). Compared with patients without acute neuroimaging findings, patients with acute neuroimaging findings had significantly higher mean Pulmonary X-ray Severity scores (5.0 [SD, 2.9] versus 9.2 [SD, 3.4], P < .001) and mean Chest CT Severity scores (9.0 [SD, 5.1] versus 12.1 [SD, 5.0], P = .041). The pulmonary x-ray severity score was a significant predictor of acute neuroimaging findings in patients with COVID-19. CONCLUSIONS: Patients with COVID-19 and acute neuroimaging findings had more severe findings on chest imaging on both radiographs and CT compared with patients with COVID-19 without acute neuroimaging findings. The severity of findings on chest radiography was a strong predictor of acute neuroimaging findings in patients with COVID-19.

A single episode of haematospermia can be safely managed in the community.

INTRODUCTION: This study is a ten-year single institution retrospective study of patients presenting with haematospermia, to establish standard tests for investigation, and what tests have low yield and can be omitted. MATERIALS AND METHODS: Investigations that were used were analysed to establish their diagnostic yield. The parameters examined were: digital rectal examination (DRE) findings, prostate specific antigen (PSA), abdominal and scrotal ultrasound, TRUS biopsy result (wherever applicable), flexible cystoscopy findings and final diagnosis. RESULTS: The central findings were that abdominal ultrasound never yielded an abnormality and that flexible cystoscopy never showed bladder tumours. TRUS prostate biopsies were performed in 17% of patients, and prostate cancer was confirmed in 5% of patients. Testicular malignancy was found in 2%. In 90% of patients, no specific diagnosis was made, and 85% of patients were discharged at review. CONCLUSIONS: A single episode of haematospermia is usually benign. Flexible cystoscopy and abdominal ultrasound appear valueless. Assessment should consist of clinical examination (including testicular), DRE and PSA testing. It can safely be managed in the community and only referred in the presence of, abnormal examination, elevated PSA or recurrent symptoms.

Low power four wave mixing in an integrated, micro-ring resonator with Q = 1.2 million.

We demonstrate efficient, low power, continuous-wave four-wave mixing in the C-band, using a high index doped silica glass micro ring resonator having a Q-factor of 1.2 million. A record high conversion efficiency for this kind of device is achieved over a bandwidth of 20 nm. We show theoretically that the characteristic low dispersion enables phase-matching over a tuning range > 160 nm.

Differential targeting of two glucose transporters from Leishmania enriettii is mediated by an NH2-terminal domain.

Leishmania are parasitic protozoa with two major stages in their life cycle: flagellated promastigotes that live in the gut of the insect vector and nonflagellated amastigotes that live inside the lysosomes of the vertebrate host macrophages. The Pro-1 glucose transporter of L. enriettii exists as two isoforms, iso-1 and iso-2, which are both expressed primarily in the promastigote stage of the life cycle. These two isoforms constitute modular structures: they differ exclusively and extensively in their NH2-terminal hydrophilic domains, but the remainder of each isoform sequence is identical to that of the other. We have localized these glucose transporters within promastigotes by two approaches. In the first method, we have raised a polyclonal antibody against the COOH-terminal hydrophilic domain shared by both iso-1 and iso-2, and we have used this antibody to detect the transporters by confocal immunofluorescence microscopy and immunoelectron microscopy. The staining observed with this antibody occurs primarily on the plasma membrane and the membrane of the flagellar pocket, but there is also light staining on the flagellum. We have also localized each isoform separately by introducing an epitope tag into each protein sequence. These experiments demonstrate that iso-1, the minor isoform, resides primarily on the flagellar membrane, while iso-2, the major isoform, is located on the plasma membrane and the flagellar pocket. Hence, each isoform is differentially sorted, and the structural information for targeting each transporter isoform to its correct membrane address resides within the NH2-terminal hydrophilic domain.

Ribonuclease-inhibitor system abnormality in dystrophic mouse skeletal muscle.

Skeletal muscle extracts from mice with muscular dystrophy contain severalfold higher than normal levels of free alkaline ribonuclease II activity and none of the free ribonuclease inhibitor normally present. This abnormal pattern is not seen in heart or liver extracts from dystrophic mice.

Blood lead levels and growth status among African-American and Hispanic children in Dallas, Texas--1980 and 2002: Dallas Lead Project II.

OBJECTIVE: The purpose of this investigation is to analyze childhood blood lead levels and growth status (ages 2-12) in Dallas, Texas lead smelter communities in the 1980s and 2002, where smelters operated from 1936 to 1990. METHODS AND MATERIALS: A sample of convenience study design was used in two cohorts (n=360): 1980-1989 (n=191) and 2002 (n=169). Multivariate analysis of variance and covariance and tandem multiple regressions were used to evaluate the association between stature and blood lead level in two time periods. RESULTS: In 2002 average child blood lead level (1.6 microg/dL+/-0.2 SE) was significantly (p<0.001) lower compared to the 1980 cohort mean level (23.6 microg/dL+/-1.3 SE). Average height and weight in 2002 were 4.5 cm and 4.0 kg greater, respectively, than in 1980. Lowered blood lead level was associated with 3.9 cm, 3.5 kg and 1.1 units greater height, weight and body mass index (BMI), respectively. Cohort effect was associated with greater height (0.6 cm), weight (0.5 kg) and BMI (0.1). CONCLUSION: This investigation reports on child growth in a community before and after the transition from high to low blood lead levels over several decades. Using child growth as a proxy, health status of Dallas's lead smelter communities increased markedly over the past two decades, primarily because of lower blood lead levels, while the poverty rate was only marginally lower.

A universal biosensing platform based on optical micro-ring resonators.

The use of optical micro-ring resonators as a platform for quantitative and qualitative biosensing applications was explored. Vertically coupled, high refractive index micro-ring resonators, used as sensing elements, were fabricated on silicon chips by photolithographic techniques. An optical reader system consisting of a near-infrared broad band light source and an optical spectrum analyzer were employed for data acquisition. Micro-ring resonator surfaces were modified with specific target receptors, including antibodies and single-stranded DNA oligonucleotides. The system was successfully used for label-free, specific, and rapid detection of whole bacterial cells, proteins and nucleic acids.

Characterization of a picosecond gated optical intensifier.

The development of high speed imaging detectors is crucial for high-temperature plasma characterization and optimization. These detectors must perform within many strict parameters, such as precise timing, high spatial resolution, low noise, high gain, and fast gating. We present test results on a picosecond gated optical intensifier that aims to meet these requirements. The detector was developed by Kentech and is part of a packaged Sydor solution of 1-8 detectors, designed for use in plasma diagnostics. It has low jitter (SD 4 ps) and gate widths less than 80 ps. We use a pulsed laser to test the gate profile and the spatial resolution performance of the intensifier at different points within the gate.

The metabolism of orally and intravenously administered labeled aldosterone in pregnant subjects.

Aldosterone metabolism has been shown to be altered in pregnancy. The increased conversion of intravenously administered aldosterone-(3)H to the acid-labile conjugate in the urine (aldosterone 18-glucuronide) has again been observed. The urinary yield of intravenously administered aldosterone-(3)H as aldosterone 18-glucuronide in 16 pregnant subjects of 13.4+/-0.9 (SE)% was significantly higher (P 0.001) than in 11 nonpregnant subjects (seven males and four females) of 7.3+/-0.5 (SE)%. After combining oral ((14)C) and intravenous ((3)H) administration of aldosterone, the (14)C/(3)H ratios of urinary metabolites (free aldosterone, tetrahydroaldosterone glucuronide, and aldosterone 18-glucuronide) were measured and were expressed as a per cent of administered dose. From these data the splanchnic extraction of aldosterone was calculated. The splanchnic extraction was significantly lower in pregnant as compared to nonpregnant subjects, although previous work indicated no change in protein binding of aldosterone in pregnancy.However, the data on the (14)C/(3)H ratio of other metabolites suggested that a large part of the increased aldosterone 18-glucuronide metabolite in pregnancy is formed in the splanchnic circulation; also, there appeared to be increased tetrahydroaldosterone glucuronide formation extrasplanchnically.

Surveillance of pneumococcal colonization and invasive pneumococcal disease reveals shift in prevalent carriage serotypes in Massachusetts' children to relatively low invasiveness.

BACKGROUND: Following the introduction of pneumococcal conjugate vaccines (PCV), overall nasopharyngeal colonization rates have not changed significantly, however a dramatic and sustained decline in invasive pneumococcal disease (IPD) in children was observed in every setting where the PCVs were implemented. We aimed to describe the differences in invasive disease potential of serotypes that are common colonizers in pre- and post-vaccine eras in order to provide further insight in our understanding of dynamic epidemiology of pneumococcal diseases. METHODS: Using data from surveillance of nasopharyngeal carriage and enhanced surveillance for IPD, a serotype specific "invasive capacity (IC)" was computed by dividing the incidence of IPD due to serotype x by the carriage prevalence of that same serotype in children <7years of age in Massachusetts. We have evaluated the serotype specific invasive capacity in two periods; pre-PCV13 (2001/02, 2003/04, 2006/07, 2008/09) and post-PCV13 (2010/11 and 2013/14), and by age groups; <24monthsvs. ≥24months. RESULTS: An approximate 50-fold variation in the point estimate was observed between the serotypes having the highest (7F, 38, 19A, 3, 33F) and the lowest (6C, 35B, 21, 11A, 23B and 23A) computed serotype specific invasive disease potential. In the post-PCV13 era (6C, 35B, 11A, 23B and 23A), 5 of the 7 most common serotypes colonizing the nasopharynx were serotypes with the lowest invasive capacity. Serotype specific invasive capacity trended down in older children for majority of the serotypes, and serotypes 3, 10A and 19A had significantly lower invasive capacity in children older than 24months of age compared to younger children. CONCLUSION: Invasive capacity differs among serotypes and likely by age. Point estimates of IC for most of the common serotypes colonizing children in Massachusetts in post-PCV13 era were low and likely explain the continued reduction in IPD from the pre-PCV era in the absence of specific protection against these serotypes.

Outdoor stocking density in free-range laying hens: radio-frequency identification of impacts on range use.

The number and size of free-range laying hen (Gallus gallus domesticus) production systems are increasing within Australia in response to consumer demand for perceived improvement in hen welfare. However, variation in outdoor stocking density has generated consumer dissatisfaction leading to the development of a national information standard on free-range egg labelling by the Australian Consumer Affairs Ministers. The current Australian Model Code of Practice for Domestic Poultry states a guideline of 1500 hens/ha, but no maximum density is set. Radio-frequency identification (RFID) tracking technology was used to measure daily range usage by individual ISA Brown hens housed in six small flocks (150 hens/flock - 50% of hens tagged), each with access to one of three outdoor stocking density treatments (two replicates per treatment: 2000, 10 000, 20 000 hens/ha), from 22 to 26, 27 to 31 and 32 to 36 weeks of age. There was some variation in range usage across the sampling periods and by weeks 32 to 36 individual hens from the lowest stocking density on average used the range for longer each day (P<0.001), with fewer visits and longer maximum durations per visit (P<0.001). Individual hens within all stocking densities varied in the percentage of days they accessed the range with 2% of tagged hens in each treatment never venturing outdoors and a large proportion that accessed the range daily (2000 hens/ha: 80.5%; 10 000 hens/ha: 66.5%; 20 000 hens/ha: 71.4%). On average, 38% to 48% of hens were seen on the range simultaneously and used all available areas of all ranges. These results of experimental-sized flocks have implications for determining optimal outdoor stocking densities for commercial free-range laying hens but further research would be needed to determine the effects of increased range usage on hen welfare.

Traumatic dislocation and successful re-enclavation of an Artisan phakic IOL with analysis of the endothelium.

PURPOSE: To present a case of traumatic dislocation of an Ophtec Artisan phakic intraocular lens (PIOL) and an analysis of the endothelial cell count. METHODS: The patient presented with blurred vision in his left eye after sustaining a brow laceration. History included uncomplicated bilateral implantation of an Artisan PIOL to correct myopia. RESULTS: The brow laceration was sutured and topical dexamethasone 0.1% qid was prescribed. One week after presentation, the PIOL was relocated. Postoperatively, endothelial cell count analysis was performed in both eyes. CONCLUSIONS: A decrease in the hexagonality of the endothelial cells was noted in both eyes, which was substantially lower in the injured eye.