Complex clinical scenarios with the use of direct oral anticoagulants in patients with atrial fibrillation: a multidisciplinary expert advisory board

The risk of developing atrial fibrillation (AF) and the risk of stroke both increase with advancing age. As such, many individuals have, or will develop, an indication for oral anticoagulation to reduce the risk of stroke. Currently, a large number of anticoagulants are available, including vitamin K antagonists, direct thrombin or factor Xa inhibitors (the last two also referred to as direct oral anticoagulants or DOACs), and different dosages are available. Of the DOACs, rivaroxaban can be obtained in the most different doses: 2.5 mg, 5 mg, 15 mg and 20 mg. Many patients develop co-morbidities and/or undergo procedures that may require the temporary combination of anticoagulation with antiplatelet therapy. In daily practice, clinicians encounter complex scenarios that are not always described in the treatment guidelines, and clear recommendations are lacking. Here, we report the outcomes of a multidisciplinary advisory board meeting, held in Utrecht (The Netherlands) on 3 June 2019, on decision making in complex clinical situations regarding the use of DOACs. The advisory board consisted of Dutch cardiovascular specialists: (interventional) cardiologist, internist, neurologist, vascular surgeon and general practitioners invited according to personal title and specific field of expertise.

     

Xerostomic medications and oral health: the Veterans Dental Study (part I)

Objectives: To quantify the adverse effects of the number of xerostomic medications on dental caries, oral mucosa, andperiodontal disease. Design: Secondary analysis of across‐sectional study of the Veterans Dental Study. Setting: Four New England area VA outpatient clinics. Subjects: The sample consists of 345 male veterans participating in The Veteran's Dental Study who also had pharmacy records. Main outcome measures: Oral health data included total surfaces of coronal caries, a modification of the root caries index, mean oral mucosa scores, and Community Periodontal Index of Treatment Need (CPITN). Oral health parameters were measured and recorded in clinical dental examinations. Exposures: Intake of xerostomic medications 14‐385 days prior to the dental examination. Statistical Analyses: The relationships between exposure and outcome were analyzed via linear and logistic regression methods adjusting for possible confounding factors such as disease burden index, alcohol consumption, dental care, and smoking status. Results: Veterans who were taking at least one xerostomic medication were almost three times more likely to have mean mucosa scores in the worst 25 percentile than veterans taking no xerostomic medications, OR= 2.63 (confidence interval [CI] 1.34,5.16, p=0.03) after adjusting for age, number of teeth, disease burden index, income, smoking and alcohol use. Participants who were taking at least one xerostomic medication experienced higher but non‐significant increases in coronal (OR =1.21; CI. 0.66, 2.25) and root caries (OR =1.10 CI. 0.54, 2.24) measured by numbers of total decayed surfaces. Conclusion: There were significant deleterious effects of xerostomic medications on oral mucosa. However, xerostomic medications do not appear to increase coronal caries, or periodontal index measured by CPITN among ambulatory, community dwelling participants who were able to perform routine preventive oral care.     

Dental anxiety among middle-aged and elderly women in Sweden. A study of oral state,utilisation of dental services and concomitant factors

The aim of this project was to investigate dental anxiety and its expression in utilisation of dental services, oral health and oral symptoms. In a cross-sectional study of women's health in Göteborg (population 432,000), Sweden, 1016 women aged 38 to 84 years participated. This randomly selected population took part in a series of investigative procedures including medical and dental clinical examinations, interviews and questionnaires. Levels of dental anxiety were measured on the Corah Dental Anxiety Scale (DAS). The average DAS score obtained was 7.2. The study showed that older women were significantly less anxious than younger ones. Severe dental anxiety (DAS 15) was experienced by 3.9% of the participants. This frequency corresponds well with findings by Hällström and Halling in their analysis of data from the first Göteborg study of women's health 24 years ago. High levels of dental anxiety were correlated with longer intervals between dental visits, poorer oral function and aesthetics and a higher frequency of oral symptoms. Headaches were more prevalent in the younger age groups and a correlation with dental anxiety was revealed. Our previous studies have shown that symptoms such as tension headaches are prevalent among dental phobic patients and that they are reported to be reduced by therapy for dental fear. The clinical and radiographical examinations revealed a generally poorer oral status, with a statistically significant higher number of decayed teeth among women with high dental anxiety.     

Spatial and temporal habitat use and selection by red deer: The use of direct and indirect methods

Given the importance of red deer Cervus elaphus for hunting and conservation purposes, understanding the interactions between this species and its habitats in the Mediterranean region is a crucial step for the sustainable management of this species. Aiming to compare pellet group counts and direct observations methods to study the habitat use and selection by red deer, the results obtained by both methods were compared, and their advantages and disadvantages were discussed. To understand the temporal patterns of habitat use and selection, the survey was conducted at three different seasons, birth period, rut season and winter. The habitat use and selection were studied in relation to land cover, watercourse, roads, ecotone zones and other topographic features (altitude, slope and aspect), using generalized linear models and selection ratios. The similarity of the results provided by pellet group counts and direct observations indicate that both methods may constitute useful tools to study the habitat use and selection by red deer. Globally, red deer seemed to select habitats that provide simultaneously food and some cover, as shown by its preference for shrublands, independently of the sampling season. The positive selection of ecotone zones embodies the need for open spaces. Males and females showed a similar use of shrubland, but selected patches with different characteristics therein. The spatial and temporal patterns exhibited by our results suggest that red deer balance their habitat requirements in respect to each phase of their reproductive cycle. Pellet group counts and direct observations seem to be useful methods to analyze habitat use and selection, and may provide helpful knowledge to the management and conservation of red deer.     

The impact of liquid-based oral cytology on the diagnosis of oral squamous dysplasia and carcinoma

OBJECTIVE: Even though diagnostic oral exfoliative cytology is a useful, economical and practical tool in the diagnosis of oral dysplasia and carcinoma, it is not yet extensively used. The results of conventional exfoliative and liquid-based diagnostic cytology in oral potentially malignant lesions (PML) are herein reported and compared with the histological diagnosis. METHODS: Either conventional (89) or liquid-based (384) exfoliative cytology was used for the diagnosis of oral dysplasia/carcinoma in 473 subjects and the results were compared with scalpel biopsy histology. Cells were collected using a Cytobrush device for conventional smears and with a dermatological curette for the liquid-based cytology. The 'curette technique' also allowed for the collection of 'accidental' tissue fragments, utilized as microbiopsies. RESULTS: Histological diagnosis was squamous carcinoma in 96 of 473 cases, high-grade dysplasia (oral intraepithelial neoplasia two to three) in 24 and other lesions in 353 cases. The smears in the conventional cytology group were inadequate in 12.4%, with an 85.7% sensitivity and a 95.9% specificity. There were 8.8% of inadequate specimens in the liquid-based cytology group; sensitivity was 95.1% and specificity was 99.0%. CONCLUSIONS: Although conventional cytology is useful when diagnosing oral PML (better sensitivity and predictive positive value if compared with the cervical smear test with similar specificity) and can improve the accuracy of histological diagnosis, liquid-based cytology gives better results, as it not only enhances both sensitivity and specificity, but also provides material for further investigation (AgNORs, DNA, microbiopsies, etc.).     

宏基因组学及其在口腔微生物研究中的应用

宏基因组是指环境中所有微生物的遗传物质总和。宏基因组学技术可以最大限度地利用环境中的微生物资源,受到了国内外微生物研究者的重点关注。口腔中寄居着大量的微生物群落,以往对口腔疾病微生物的研究大多局限于单纯的细菌培养技术,然而,由于培养技术的局限性,部分微生物很难或根本不能培养,宏基因组学技术打破了这一局限性,帮助人类发掘更丰富的口腔微生物资源。最近,以宏基因组学测序为基础的研究描绘出了口腔生态系统的图谱,越来越多的实验证明口腔微生物组在各种口腔疾病甚至全身系统性疾病中的重要作用。同时,这也为基于人类微生物组的诊断和治疗开辟了新的途径。本综述旨在说明宏基因组学是研究人类口腔疾病及全身疾病相关微生物的得力工具,而且具有广阔的发展前景,同时也讨论了宏基因组学在应用中有待克服的局限性。     

The direct and indirect effects of insectivory by birds in two contrasting Neotropical forests

A goal among community ecologists is to predict when and where trophic cascades occur. For example, several studies have shown that forest birds can limit arthropod abundances on trees, but indirect effects of bird predation (i.e. decreased arthropod damage to trees) are not always observed and their context is not well understood. Because productivity is one factor that is expected to influence trophic cascades, we compared the extent to which birds indirectly limit herbivore damage to trees in two lowland Neotropical forests that differed in seasonality of leaf production and rainfall. We compared the effects of bird predation on local arthropod densities and on damage to foliage through a controlled experiment using bird exclosures in the canopy and understory of two forests. We found that birds decreased local arthropod densities and leaf damage in the canopy of the drier site during periods of high leaf production, but not in the wetter forest where leaf production was low and sporadic throughout the year. Birds had no effect on arthropod abundances and leaf damage in the understory where leaf production and turnover rates were low. In support of these experimental interpretations, although we observed that arthropod densities were similar at the two sites, bird densities and the rate at which birds captured arthropods were greater at the drier, seasonally productive site. The influence of top-down predation by birds in limiting herbivorous insects appears to be conditional and most important when the production and turnover of leaves are comparatively high. Figure legends were missing in the original article published under Plant Animal Interactions, Oecologia (2005) 143: 106–166. The complete article is repeated here. The online version of the original article can be found at     

Oral microbial flora and oral malodour of the institutionalised elderly in Japan

Objectives: To determine the oral health status, especially the level of oral microbial flora and oral malodour, of institutionalised elderly people compared with non‐institutionalised elderly people. Setting: Three institutions and numerous private homes. Subjects: 56 institutionalised and 56 non‐institutionalised elderly people. Main Outcome Measures: Institutionalised elderly people had higher levels of Candida, staphylococci, and oral malodour. Results: Institutionalised elderly people had a higher level of Candida in denture wearers, and a higher level of staphylococci and oral malodour compared with the non‐institutionalised elderly. Conclusion: The institutionalised elderly have a higher risk of opportunistic infections and oral health care should be improved to protect them from these infections and to reduce oral malodour.     

The direct and indirect effects of insectivory by birds in two contrasting Neotropical forests

A goal among community ecologists is to predict when and where trophic cascades occur. For example, several studies have shown that forest birds can limit arthropod abundances on trees, but indirect effects of bird predation (i.e. decreased arthropod damage to trees) are not always observed and their context is not well understood. Because productivity is one factor that is expected to influence trophic cascades, we compared the extent to which birds indirectly limit herbivore damage to trees in two lowland Neotropical forests that differed in seasonality of leaf production and rainfall. We compared the effects of bird predation on local arthropod densities and on damage to foliage through a controlled experiment using bird exclosures in the canopy and understory of two forests. We found that birds decreased local arthropod densities and leaf damage in the canopy of the drier site during periods of high leaf production, but not in the wetter forest where leaf production was low and sporadic throughout the year. Birds had no effect on arthropod abundances and leaf damage in the understory where leaf production and turnover rates were low. In support of these experimental interpretations, although we observed that arthropod densities were similar at the two sites, bird densities and the rate at which birds captured arthropods were greater at the drier, seasonally productive site. The influence of top-down predation by birds in limiting herbivorous insects appears to be conditional and most important when the production and turnover of leaves are comparatively high.Electronic Supplementary Material Supplementary material is available for this article at     

A histochemical comparison of methyl green-pyronin,and hematoxylin and eosin for detecting apoptotic cells in oral squamous cell carcinoma,oral leukoplakia,oral submucous fibrosis and normal oral mucosa

Abstract

Analysis of apoptotic cells in oral pathological states could be useful for determining the rates of tissue turnover, which would help determine prognosis. The use of histochemical stains such as hematoxylin and eosin (H & E) and methyl green-pyronin (MGP) can provide a simple and cost-effective method for detecting apoptotic cells. We compared the efficacy of MGP and H & E for detecting apoptotic cells in oral squamous cell carcinoma (OSCC), oral leukoplakia (OL), oral submucous fibrosis (OSMF) and normal oral mucosa (NOM). Ten cases each of OSCC, OSMF, OL and NOM were retrieved from the archives and two serial sections were stained, one with H & E and the other with MGP. Apoptotic cells were identified at 100 x magnification and the apoptotic index was calculated. Apoptotic cells were distinguished more readily in MGP stained sections than in those stained with H & E. Also, the apoptotic cell count was greater in OSCC compared to OL, OSMF and NOM. We concluded that MGP staining can be used as a routine, cost-effective method for detecting apoptotic cells.     

Interactions between Limonium vulgare and Plantago maritima in the Plantagini-Limonietum on the Boschplaat,Terschelling, The Netherlands

Limonium vulgare and Plantago maritima are growing together over large areas and in varying proportions on the Boschplaat salt marsh. The question is how both species interact and which environmental factors play a role in those interactions.There are indications of different measures of niche differentiation in the Plantagini-Limonietum association related to differences in flooding frequency and substrate. Interactions between both species are described according to three models (related to de Wit's competition model). Mechanisms that may cause niche differentiation are: differences in growth rhythm, in salt tolerance, in rooting depth, in preference to types of substrate, in morphology, in mycorrhizae and diseases.On a small scale (spatial heterogeneity in the marsh and variation in subsequent seasons) Limonium can achieve a bigger portion in the vegetation by occupying open sites faster than Plantago. On a larger scale (the whole marsh, decades) the impossibility of Plantago to germinate and rejuvenate after sedimentation of silt and salinisation of the soil is the determining factor causing an overall decrease of this species (compared with Limonium) and increase of Limonium.The life cycle of both species, criteria for scale in space and time, and the question whether the Plantagini-Limonietum should be considered a syntaxon, are discussed.Nomenclature follows Heukels-van Ooststroom (1977).I like to thank Dr. P. Ketner and Dr. C. J. T. Spitters for their accompaniment and their ideas, so that I was aware of the wood (Boschplaat) for the trees. I also like to thank Drs. A. J. M. Roozen and Prof. Dr. E. van der Maarel for their discussions about this subject on many occasions. Finally I would like to thank Dr. W. G. Beeftink for his ideas and support and Ron Don, Wim van Hooff, Sjef Jansen, Alex Jonker, Annemiek Demon, Wim Heijligers, Marlie Becks and Frans Wilms for providing the basic concept (the Plantagini-Limonietum) and for their help.     

The use of oral prostaglandin E2 in the management of intrauterine fetal death

12 otherwise healthy patients with intrauterine fetal death 1 to 6 weeks earlier were treated with oral prostaglandin E₂. 9 of the 12 patients delivered within 48 hours after treatment began. 2 others delivered within 48 hours after unsuccessful treatment ceased. In a third patient the cervix relaxed after treatment, and the uterine contents were removed by curettage. No serious complications, such as hemorrhage occurred. The uterus seemed surprisingly responsive to oral prostaglandin E₂ in cases of intrauterine fetal death.     

The clinical evaluation of the oral status in Alzheimer-type dementia patients

doi: 10.1111/j.1741‐2358.2010.00401.x
The clinical evaluation of the oral status in Alzheimer‐type dementia patients Background: To evaluate the oral health status in patients with Alzheimer dementia (AD), and the association of the disease severity with the oral findings. Methods: The study was conducted on the study group (31 AD patients) and the control group (47 healthy volunteers) from the Neurology Department of the Institute. Cognitive status was evaluated with the MMSE scoring system. Oral parameters, such as decaying, missing, filled teeth (DMFT) index and teeth present (PT) were evaluated in the patients. Oral hygiene status, denture status and mucosal lesions, including denture‐induced stomatitis were also investigated. Results: The study was conducted on the study group (31 AD patients) and the control group (47 healthy volunteers). Tooth brushing and denture cleaning were irregular in 22 of 31 (70%) patients with AD. The ratio of the subjects who forgot to remove their denture during the night was significantly higher in the study group than in the control group (p < 0.001). In this study, decreased cognitive functions in AD patients have been demonstrated to result in a deterioration of denture care and increased denture‐related mucosal lesions. Conclusions: These findings were considered due to decreased denture care including the non‐removal of the denture in the night in the patients with decreased cognitive functions.     

Evaluation of an oral function promotion programme for the independent elderly in Japan

Objectives: The purpose of this study was to provide an oral function promotion programme for the independent elderly and evaluate the changes in oral health status and oral function. Background: Few studies have scientifically analysed and evaluated the effectiveness of oral function promotion programmes provided for the independent elderly. Materials and methods: The subjects were independent elderly females (mean age: 74.6 ± 6.3) recruited from senior citizens’ centres in Tokyo. The intervention group (n = 79) received a 3‐month oral function promotion programme, which included facial muscle and tongue exercises and salivary gland massages. The control group (n = 62) did not receive this programme. Results: In the intervention group, the tongue coating scores decreased and the organoleptic score of oral malodour fell. The amount of food debris in the oral cavity decreased and the tongue dryness improved. Furthermore, the salivary flow rate increased. The length of time for maintaining the tongue in the forward position increased from 11.2 s to 18.7 s, and the number of times for moving the tip of the tongue in a clockwise circular motion, counter‐clockwise circular motion and side‐to‐side motion within 30 s, increased from 14.5 to 20.6, 14.5 to 20.2, and 17.2 to 23.3 respectively. The number of times for movement of the lips significantly improved from 23.0 to 28.8 and the pronunciation of words was observed to be clearer. Conclusion: An oral function promotion programme was effective in improving the oral health status and oral function of an independent elderly population.