Association of Oral Health with Frailty, Malnutrition Risk and Functional Decline in Hospitalized Older Adults: A Cross-Sectional Study.

BACKGROUND: Poor oral health is known to be associated with adverse outcomes, but the frequency and impact of poor oral health on older adults in the acute inpatient setting has been less well studied. OBJECTIVES: We examined the association between oral health, frailty, nutrition and functional decline in hospitalized older adults. DESIGN: Retrospective cross-sectional study. SETTING AND PARTICIPANTS: We included data from 465 inpatients (mean age 79.2±8.3 years) admitted acutely to a tertiary hospital. METHODS: We evaluated oral health using the Revised Oral Assessment Guide (ROAG), frailty using the Clinical Frailty Scale (CFS), malnutrition risk using the Nutritional Screening Tool (NST) and functional status using a modified Katz Activities of Daily Living (ADL) scale. We examined cross-sectional associations of oral health with frailty, malnutrition risk and functional decline on admission, followed by multivariate logistic regression models evaluating the association between poor oral health and the aforementioned outcomes. RESULTS: 343 (73.8%), 100 (21.5%) and 22 (4.7%) were classified as low, moderate and high risk on the ROAG, respectively. Poorer oral health was associated with greater severity of frailty, functional decline on admission and malnutrition risk. Abnormalities in ROAG domains of voice changes, swallowing difficulty, xerostomia, lips and tongue appearance were more frequently present at greater severity of frailty. Poor oral health was associated with frailty [odds ratio (OR): 1.76, 95% confidence interval (CI) 1.05-2.97; P=0.034]; malnutrition risk [OR: 2.76, 95% CI 1.46-5.19, P=0.002] and functional decline [OR: 1.62, 95% CI 1.01-2.59, P=0.046]. CONCLUSIONS: Poor oral health is significantly associated with frailty, malnutrition risk and functional decline in older inpatients. Oral health evaluation, as part of a comprehensive geriatric assessment may be a target for interventions to improve outcomes. Further research including longitudinal outcomes and effectiveness of specific interventions targeted at oral health are warranted in older adults in the inpatient setting.

Clinical significance of circ-MTHFD2 in diagnosis, pathological staging and prognosis of NSCLC.

OBJECTIVE: To explore the clinical significance of circ-MTHFD2 in the diagnosis, pathological staging, and prognosis of non-small cell lung cancer (NSCLC). PATIENTS AND METHODS: A total of 100 pairs of cancer tissues and adjacent tissues were surgically removed from NSCLC patients treated from July 2011 to January 2013 in our hospital were selected. All tissue samples were pathologically confirmed. Real Time-Polymerase Chain Reaction (qRT-PCR) was adopted to detect the expression of circ-MTHFD2 in NSCLC samples and its characteristic as a circular ribonucleic acid (circRNA). The receiver operating characteristic (ROC) curve was drawn to determine the diagnostic potential of circ-MTHFD2 in NSCLC. The relationship between circ-MTHFD2 expression and the clinical characteristics of NSCLC patients was analyzed by the χ2-test. Kaplan-Meier survival curves were depicted to assess the prognostic potential of circ-MTHFD2 in NSCLC. The effect of circ-MTHFD2 on the overall survival rate of NSCLC patients was uncovered by introducing the Cox proportional hazards model. RESULTS: The expression of circ-MTHFD2 in cancer tissues of NSCLC patients was higher than that in adjacent tissues (p<0.05), and there was no remarkable difference in the expression of circ-MTHFD2 before and after RNase R digestion (p>0.05). The area under the curve (AUC) of circ-MTHFD2 ROC was 0.701, with the cut-off value of 3.534, 90% sensitivity and 71% specificity. Circ-MTHFD2 expression was closely associated with smoking history, tumor size, tumor-node-metastasis (TNM) stage, lymph node metastasis, and recurrence in NSCLC patients (p<0.05). The prognosis of NSCLC patients with high expression of circ-MTHFD2 was evidently poorer than those with low expression. High expression of circ-MTHFD2 was an independent risk factor affecting the prognosis in NSCLC (p<0.05). CONCLUSIONS: The high expression of circ-MTHFD2 has clinical significance in the diagnosis, pathological staging, and prognosis of NSCLC.

Various doses of fractioned irradiation modulates multidrug resistance 1 expression differently through hypoxia-inducible factor 1α in esophageal cancer cells.

To evaluate the effect of different regimen of radiotherapy on multidrug resistance 1 (MDR1) expression and analyze the role hypoxia-inducible factor 1α (HIF1α) played in the whole process. Fifty-four cell lines established from 96 esophageal cancer biopsy samples were given various doses of fractioned irradiation. The mRNA and protein levels of HIF1α and MDR1 post-irradiation were measured by quantitative reverse transcription-polymerase chain reaction and Western blot analysis, respectively. HIF1α-siRNA was used to verify the effect of HIF1α on radiation-mediated MDR1 modulation. In esophageal cancer cells surviving 28 Gy irradiation (2 Gy/f, 14 fractions), MDR1 mRNA expression increased 65.27 ± 5.58%, and HIF1α was elevated by 27.21 ± 2.25%. Interestingly, their expression decreased by 54.38 ± 11.53% and 32.08 ± 4.75% after 7 Gy irradiation (0.5 Gy/f, 14 fractions). HIF1α expression showed a positive correlation with MDR1 expression in the whole process (P < 0.05). Silencing of HIF1α decreased MDR1 expression and blocked changes in MDR1 and HIF1α expression induced by fractioned irradiation. These results indicate that MDR1 is differentially modulated by different doses of fractionated radiation, which should be taken into account when combining radiotherapy and chemotherapy for patients with esophageal cancer.

[Effect of gamma-irradiation on infectivity of Clonorchis sinensis metacercariae].

The purpose of the present study was to observe the survival and development of Clonorchis sinensis metacercariae in their final hosts after Co-60 gamma irradiation exerting on both metacercariae isolated or in fish. Guinea pigs or albino rats were orally infected by gavage. Bio-assay, fecal examination for ova and dissection of infected animals were used for the estimation of minimum effective dose of gamma irradiation to control infectivity of Clonorchis sinensis metacercariae. Results showed that the minimum effective irradiation dose for isolated metacercariae was 0.05 kGy. The LD50 of the irradiation dose for metacercariae in fish was 0.05 kGy, and the minimum effective dose was 0.15 kGy. No significant difference in radiation susceptibility to Co-60 gamma irradiation was found among Clonorchis sinensis metacercariae in fishes collected at different localities in the northern, middle or southern parts of China. The present finding suggests that irradiation of the fish at a dose of 0.15 kGy could control the infectivity of Clonorchis sinensis metacercariae and thus be adopted as a control measure in preventive medicine.