A comprehensive risk factor analysis using association rules in people with diabetic kidney disease.

Association rule is a transparent machine learning method expected to share information about risks for chronic kidney disease (CKD) among diabetic patients, but its findings in clinical data are limited. We used the association rule to evaluate the risk for kidney disease in General and Worker diabetic cohorts. The absence of risk factors was examined for association with stable kidney function and worsening kidney function. A confidence value was used as an index of association, and a lift of > 1 was considered significant. Analyses were applied for individuals stratified by KDIGO's (Kidney Disease: Improving Global Outcomes) CKD risk categories. A General cohort of 4935 with a mean age of 66.7 years and a Worker cohort of 2153 with a mean age of 47.8 years were included in the analysis. Good glycemic control was significantly related to stable kidney function in low-risk categories among the General cohort, and in very-high risk categories among the Worker cohort; confidences were 0.82 and 0.77, respectively. Similar results were found with poor glycemic control and worsening kidney function; confidences of HbA1c were 0.41 and 0.27, respectively. Similarly, anemia, obesity, and hypertension showed significant relationships in the low-risk General and very-high risk Worker cohorts. Stratified risk assessment using association rules revealed the importance of the presence or absence of risk factors.

Perioperative oral care can prevent surgical site infection after colorectal cancer surgery: A multicenter, retrospective study of 1,926 cases analyzed by propensity score matching.

BACKGROUND: Surgical site infection is a common postoperative complication of colorectal cancer surgery, and surgical site infection increases medical costs, prolongs hospitalization, and worsens long-term prognosis. Perioperative oral care has been reported to be effective in preventing postoperative pneumonia, although there are only a few reports on its effectiveness in preventing surgical site infection. This study aimed to determine the role of perioperative oral care in surgical site infection prevention after colorectal cancer surgery. METHODS: In this study, 1,926 patients with colorectal cancer from 8 institutions were enrolled; 808 patients (oral care group) received perioperative oral care at the hospital's dental clinic, and 1,118 (control group) did not receive perioperative oral care. The data were matched by propensity score to reduce bias. Ultimately, a total of 1,480 patients were included in the analysis. RESULTS: The incidence of surgical site infection was significantly lower in the oral care group than in the control group (8.4% vs 15.7%, P < .001). Multivariate logistic regression analysis revealed 4 independent risk factors for surgical site infection: low albumin level, rectal cancer, blood loss, and lack of perioperative oral care. Lack of perioperative oral care had an odds ratio of 2.100 (95% confidence interval 1.510-2.930, P < .001). CONCLUSION: These results suggest that perioperative oral care can reduce the incidence of surgical site infection after colorectal cancer resection. Perioperative oral care may have an important role in the future perioperative management of colorectal cancer as a safe and effective method of surgical site infection prevention, although further validation in prospective studies is needed.

Proper oral hygiene protocols decreased inflammation of gingivitis in a patient during chemotherapy with bevacizumab: a case report.

The case is a woman who had a diagnosis of ovarian cancer and endometrial cancer. After surgical therapy, platinum-based adjuvant treatment was performed, followed by additional bevacizumab administration. Because considerable gingivitis appeared, a proper approach for oral hygiene was performed. As a result, the symptom was reduced considerably.

Purification of a novel fibronectin binding protein from 'Granulicatella para-adiacens'.

The interaction of microorganisms with fibronectin plays an important role in infective endocarditis. Characterization of fibronectin binding is not sufficient for nutritionally variant streptococci (NVS), which is an important pathogen associated with this disease. In this study, we identified and purified the novel fibronectin binding protein (FBP) by sonication and column chromatography from a ' Granulicatella para-adiacens' strain isolated from the oral cavity of a healthy donor. The purified molecule was located at the top of the gel in SDS-PAGE analysis, and heat treatment in the presence of sodium dodecyl sulfate resulted in its dissociation into smaller molecules. An anti-purified protein antibody was reacted with the topmost component of the sonic extract only from two ' G. para-adiacens' strains in Western blot analyses. Immunofluorescence staining indicated that the protein of interest was located on the cell surface of ' G. para-adiacens', but not on other NVS species. Bacterial adherence to fibronectin was inhibited by the purified FBP preparation. Optimum conditions for fibronectin binding of purified FBP were shown to be an NaCl concentration higher than 150 mM and a pH of c. 7.0. These results provide additional information for the elucidation of fibronectin binding by NVS.

Gene cloning and characterization of Streptococcus intermedius fimbriae involved in saliva-mediated aggregation.

Streptococcus intermedius, an oral commensal and a cause of systemic pyogenic disease, expresses fimbriae. To identify the gene(s) encoding these fimbriae, we used a serum raised against purified fimbriae to screen libaries of recombinant lambda phages. The cloned gene cluster encoding S. intermedius fimbriae, (saliva-mediated aggregation and adherence-associated fimbriae), contained 4 ORFs, i.e. a putative ribonulease (Saf1), a putative adhesin (Saf2), the main pilus subunit (Saf3) and a sortase C (SrtC). Escherichia coli strains harboring recombinant phages and plasmids carrying the saf3 gene produced a 55kDa protein recognized by the antifimbriae serum. Saf3 contains an N-terminal signal sequence and a C-terminal cell-wall-anchoring motif LPXTG. Among strains of the Streptococcus anginosus group, only serotype g and untypable strains were found to contain the saf3 gene, to possess the fimbrial antigen and to exhibit saliva-mediated aggregation. Knockout mutants made by insertion of an erythromycin resistance gene into saf3 did not produce fimbrial structures or fimbrial antigens and did not participate in saliva-mediated aggregation. The adherent activity of mutants toward plastic wells coated with salivary agglutinin was about 65% that of the parental strain, and the reaction depended on calcium. There was no significant difference in adherence to hydroxyapatite beads pretreated with salivary agglutinin between the parental and mutant strains. These results demonstrated that Saf3 is associated with aggregation, and suggested that other molecule(s) are associated with adherence of S. intermedius.

Relative longitudinal motion of the finger flexors, subsynovial connective tissue, and median nerve before and after carpal tunnel release in a human cadaver model.

PURPOSE: The normal gliding environment in the carpal tunnel is complex. The median nerve and flexor tendons are surrounded by a multilayered subsynovial tissue. To date, observations of the relative motions of the flexor tendon, median nerve and multilayered subsynovial tissue have been through a surgically released open carpal tunnel. The purpose of this study was to compare the motions of these tissues in an intact and open carpal tunnel. METHODS: We measured the relative motion of the middle finger flexor digitorum superficialis tendon, its surrounding subsynovial connective tissue (SSCT) and the median nerve in 8 human cadavers. The flexor retinaculum was used as a fixed reference point. The motions were compared for simulated isolated middle finger and simulated fist motion as measured fluoroscopically in the closed carpal tunnel and directly in the open carpal tunnel. RESULTS: While the simulated isolated finger motion produced significantly less SSCT and median nerve motion (p<.05), there was no difference in flexor digitorum superficialis, SSCT, or nerve motion when comparing the fluoroscopic measurements in the closed carpal tunnel with the direct visual measurements in the open carpal tunnel. CONCLUSIONS: Relative motion of the flexor tendons, SSCT, and median nerve within the carpal tunnel follows a certain pattern, which may indicate the physiological state of the SSCT. This relative motion pattern was not affected by flexor retinaculum release.

The mechanical properties of the rabbit carpal tunnel subsynovial connective tissue.

The rabbit model is commonly used to study carpal tunnel syndrome (CTS). It has been proposed that the subsynovial connective tissue (SSCT) in the carpal tunnel may play a role in the etiology of CTS, but the material properties of the rabbit SSCT are unknown. The purpose of this study was to develop a method to measure the shear properties of the rabbit SSCT. In six rabbit cadaver forepaws, the excursion of the third digit flexor digitorum superficialis (FDS) and load to failure of the SSCT were measured in a custom device. The mean excursion to full flexion in this model was 7.08mm (S.D. 0.77). The mean shearing force at full flexion was 317 mN (S.D. 166). At full flexion percentage of maximum shear force in the SSCT was 54.5% (S.D. 19.4). The mean energy absorbed at full flexion was 0.29mJ (S.D. 0.31). The mean excursion needed to reach 5% of the maximum shear force was 3.04mm (S.D. 0.99). The testing model presented in this study demonstrates structural parameters to evaluate the shear properties of the SSCT in a rabbit model. The data presented could be used for estimating sample sizes in a more comprehensive study of the effect of CTS on the SSCT properties.

Transgenic mouse lines expressing Cre recombinase specifically in posterior notochord and notochord.

During development, the organizer provides instructive signals to surrounding cells as well as contributing cells to axial structures. To dissect organizer function at different developmental stages, conditional approaches such as the Cre/loxP system for conditional mutagenesis are particularly useful. Here we describe two new Cre transgenic mouse lines, Foxa2 NFP-Cre and Nodal PNC-Cre, with activity in two organizer domains, the posterior notochord (PNC) and notochord. These lines were made using defined regulatory elements from the Foxa2 and Nodal genes that direct Cre expression in overlapping domains of the PNC and notochord. Our detailed analysis of the timing and location of Foxa2 NFP-Cre and Nodal PNC-Cre activity indicates that these lines are appropriate for conditional mutagenesis of genes expressed from early somite stages onward.

Candidate human papillomavirus (HPV) type 27b: nucleotide sequence and heterogeneity with HPV 27.

More than 100 human papillomavirus (HPV) types have been reported as tumorigenic agents. HPV types 2 and 27 were identified in benign tumors and classified closely according to the sequence homology. An HPV type 2 related sequence was identified previously in an oral papilloma. However, the correct typing and sequencing was impossible at that time. A candidate HPV was cloned by the long-PCR technique from an oral papilloma and characterized by nucleotide sequence. This virus was basically HPV type 27, but there was some heterogeneity in comparison with the prototype. Most differences were nucleotide-sequence variations. Two of four-nucleotide insertions were frame shift, resulting in longer L1 protein than that of HPV 27.

Mutation of SENP1/SuPr-2 reveals an essential role for desumoylation in mouse development.

The covalent modification of proteins by the small ubiquitin-like protein SUMO has been implicated in the regulation of numerous biological processes, including nucleocytoplasmic transport, genomic stability, and gene transcription. Sumoylation occurs by a multienzyme process similar to ubiquitination and, in Saccharomyces cerevisiae, is reversed by desumoylating enzymes encoded by the Ulp1 and Smt4/Ulp2 genes. The physiological importance of desumoylation has been revealed by mutations in either gene, which lead to nonoverlapping defects in cell cycle transition and meiosis. Several mammalian Ulp homologues have been identified, but, to date, nothing is known of the phenotypic effects of their loss of function. Here, we describe a random retroviral insertional mutation of one homolog, mouse SENP1/SuPr-2. The mutation causes increased steady-state levels of the sumoylated forms of a number of proteins and results in placental abnormalities incompatible with embryonic development. Our findings provide the first insight into the critical importance of regulating sumoylation in mammals.

Isolation and some properties of fimbriae of oral Streptococcus intermedius.

Streptococcus intermedius 1208-1 carried linear fiber-like fimbriae that extended radially from the cell surface. The fimbriae were isolated by pipetting and sonication and were purified by ammonium sulfate precipitation followed by a column chromatography series. Heat treatment in the presence of sodium dodecyl sulfate resulted in the dissociation into smaller molecules. Rabbit antiserum raised against the purified protein reacted with fimbriae on the surface of bacteria under immunogold staining. Serotype g or g-related strains produced the fimbriae and aggregated in human saliva. The aggregation was inhibited by the anti-fimbriae immunoglobulin Fab fragment or the purified fimbriae.

Human salivary aggregation in Streptococcus intermedius type g strains: relationship with IgA.

Bacterial aggregation is an important step in elimination from the human body to protect against infection. Streptococcus intermedius K1K aggregates in human saliva. In this study, the salivary agglutinin was identified. The aggregation level was very strong in sonic-treated saliva and 1-microm filtrate. Preincubation of human saliva with anti-human alpha chain serum or anti-human whole saliva serum completely inhibited aggregation, but preincubation with anti-human micro chain serum or anti-Fc fragment of human IgG serum had no effect. Agglutinin of human saliva that could aggregate the strain K1K was purified using DEAE-Sepharose CL-6B, Phenyl-Sepharose CL-4B and Sephacryl S200HR gel filtration. Purified salivary agglutinin was characterized with electrophoresis and immunological techniques, indicating that purified material was IgA. Bacterial aggregation was dependent on the presence of calcium. Saliva filtrate specimens from eight healthy men and eight women showed different aggregation activities. Three men and one woman had little activity. These data show that the present bacterial aggregation was an immunoreaction between IgA in saliva and the bacteria dependent on the levels of calcium. In addition, the IgA in human saliva related with possible calcium-dependent antigen(s) on the surface of strain K1K.

Purification of saliva agglutinin of Streptococcus intermedius and its association with bacterial aggregation and adherence.

Streptococcus intermedius strain 1208-1 cells were aggregated in the presence of saliva. The saliva agglutinin was purified by centrifugation, filtration, and gel filtration. SDS-PAGE analyses indicated that the purified agglutinin consisted of two high-molecular-mass proteins. Aggregation was dependent on calcium over pH 5.5, with 1 mM being the most effective concentration. Boiling inactivated purified agglutinin. S. intermedius strain 3 and Streptococcus mutans strain 1 were aggregated in the purified agglutinin. After adsorption with strain 1208-1 cells, the saliva sample did not exhibit any aggregation activity, and the agglutinin bands were no longer visible by SDS-PAGE. Adherence analyses demonstrated that the purified agglutinin immobilized on the surfaces of polystyrene wells, actinomyces cells, and apatite beads accounted for the binding of streptococcus cells. Agglutinin also effectively inhibited adherence to apatite beads coated with native saliva.