Aims/hypothesis Inflammation plays an important role in the development of diabetes, a major global health problem. Periodontal disease is also common in the general population. Because periodontal disease and poor oral hygiene can provoke transient bacteraemia and systemic inflammation, we hypothesised that periodontal disease and oral hygiene indicators would be associated with the occurrence of new-onset diabetes. Methods In this study we analysed data collected between 2003 and 2006 on 188,013 subjects from the National Health Insurance System-Health Screening Cohort (NHIS-HEALS) in Korea who had no missing data for demographics, past medical history, oral hygiene indicators or laboratory findings. The presence of periodontal disease was defined on the basis of a modified version of ICD-10 codes (Korean Classification of Disease, sixth edition), if claims for treatment for acute periodontitis (K052), chronic periodontitis (K053) and periodontosis (K054) were made more than two times by a dentist, or if, according to medical records, subjects received treatment by a dentist for periodontal disease with ICD-10 codes K052, K053 or K054. Oral hygiene behaviours (number of tooth brushings, a dental visit for any reason and professional dental cleaning) were collected as selfreported data of dental health checkups. Number of missing teeth was ascertained by dentists during oral health examination. The incidence of new-onset diabetes was defined according to ICD-10 codes E10-E14. The criterial included at least one claim per year for both visiting an outpatient clinic and admission accompanying prescription records for any glucose-lowering agent, or was based on a fasting plasma glucose ≥7 mmol/l from NHIS-HEALS. Results Of the included subjects, 17.5% had periodontal disease. After a median follow-up of 10.0 years, diabetes developed in 31,545 (event rate: 16.1%, 95% CI 15.9%, 16.3%) subjects. In multivariable models, after adjusting for demographics, regular exercise, alcohol consumption, smoking status, vascular risk factors, history of malignancy and laboratory findings, the presence of periodontal disease (HR 1.09, 95% CI 1.07, 1.12, p < 0.001) and number of missing teeth (≥15 teeth) remained positively associated with occurrence of new-onset diabetes (HR 1.21, 95% CI 1.09, 1.33, p < 0.001, p for trend <0.001). Frequent tooth brushing (≥3 times/ day) was negatively associated with occurrence of new-onset diabetes (HR 0.92, 95% CI 0.89, 0.95, p < 0.001, p for trend <0.001). Conclusions/interpretation Frequent tooth brushing may be an attenuating factor and the presence of periodontal disease and an increased number of missing teeth may be augmenting factors for the occurrence of new-onset diabetes. Improving oral hygiene may be associated with a decreased risk of occurrence of new-onset diabetes.

Background: Neutrophil extracellular traps (NETs) participate in innate immunity by trapping microorganisms. Their pathophysiological implications have not been defined in chronic rhinosinusitis (CRS). Objective: We investigated the presence of NETs in nasal secretion of patients with stable or exacerbated CRS and evaluated whether NETs participate in the secretion of chemokines in sinonasal epithelial cells, the epithelial permeability, and transendothelial leucocyte migration, and elucidate whether NETs are released by macrolides and dexamethasone. Methods: The presence of NETs in nasal secretion and the release of NETs from neutrophils stimulated with macrolides or dexamethasone were evaluated by dsDNA Assay kit and fluorescence microscope. The chemokine secretion, epithelial permeability, and transendothelial leucocyte migration were measured in cultured cells incubated with NETs, the supernatant of unstimulated neutrophils (unstim), NETs inhibitor (DPI), or H3Cit, where the expression of junctional complex proteins and ICAM-1 was evaluated by real-time PCR, Western blots, and confocal microscope. Results: The amount of NETs and NETs-forming neutrophils in nasal secretion increased in exacerbated CRS. Epithelial cells treated with NETs or H3Cit secreted chemokines and showed decreased permeability associated with up-regulated junctional complex proteins. Increased transendothelial leucocyte migration associated with up-regulated ICAM-1 was noted in endothelial cells treated with NETs or H3Cit.These findings were not found in cells treated with unstim, or DPI. NETs were released by macrolides, but not by dexamethasone. Conclusions and Clinical Relevance: NETs formation increased in exacerbated CRS,inducing chemokine secretion, strengthening the epithelial barrier, and promoting the neutrophils infiltration. Therefore, the release of NETs in CRS might be beneficial or detrimental to CRS patients. K E Y W O R D Schemokines, dexamethasone, epithelial permeability, macrolides, neutrophil extracellular traps, transendothelial leucocyte migration

Polyelectrolyte complex (PEC) hydrogels composed of various weight ratios of chitosan and hyaluronic acid were prepared. The PEC hydrogels were formed by the reaction of the oppositely charged chitosan polymers. The PEC films swelled in water rapidly, reaching equilibrium within 30 min, and exhibited relatively high swelling ratios, 243-322%, at 25°C. The swelling ratio increased with increasing temperature. The transport phenomena of all PEC samples were non-Fickian and diffusion and relaxation controlled. The diffusion coefficients of the PEC films ranged from 2.22 ϫ 10 Ϫ6 to 10.05 ϫ 10 Ϫ6 cm 2 /s. The activation energy of the polyelectrolyte complexes ranged from 37.14 to 54.58 kJ/mol and proved to be hydrophilic.

An interpenetrating polymer network (IPN) hydrogel based on poly(propylene glycol) and poly(acrylic acid) was prepared by UV irradiation. The swelling behavior of the IPN hydrogel was studied by the immersion of the gel in aqueous NaCl solutions of various concentrations. The swelling ratio decreased with an increase in the NaCl concentration. The electrically sensitive behavior of the IPN hydrogel in electric fields was also investigated. The IPN hydrogel also showed a stepwise bending behavior that depended on the electric stimulus. The bending angle and bending speed of the IPN hydrogel were greatest in 0.6 wt % aqueous NaCl and increased with an increase in the applied voltage.

ABSTRACT:Interpenetrating polymer network (IPN) hydrogels composed of poly(vinyl alcohol) (PVA) and monomer, N-isopropylacrylamide (NIPAAm), diallyldimethylammonium chloride (DADMAC), or methacrylic acid (MAA) were prepared by using the sequential-IPN method. The equilibrium swelling ratios of PVA/NIPAAm (VANP), PVA/DADMAC (VADC), and PVA/MAA (VAMA) are 412, 370, and 297 at 25°C, respectively. VANP had the highest swelling ratio in time-dependent swelling behavior, whereas the swelling ratio of VAMA had the lowest. The n values of VANP, VADC, and VAMA are 0.72, 0.81, and 0.96, respectively. Transport of all IPN hydrogels is anomalous and their transport mechanisms are dominated by a combination of diffusion-controlled and relaxation-controlled systems. VAMA has the highest activation energy and VANP has the lowest activation energy. The values of all IPN hydrogels are from 4.66 to 16.49 kJ/mol, which proves that all IPN hydrogels are hydrophilic.

Background Frailty aggregates a composite of geriatric and elderly features that is classified into a singular syndrome; literature thus far has proven its influence over postoperative outcomes. In this study, we evaluate the effects of frailty following gastrectomy for gastric cancer. Methods 2011-2017 National Inpatient Sample was used to isolate patients with gastric cancer undergoing gastrectomy; from this, the Johns Hopkins ACG frailty criteria were applied to segregate frailty-present and absent populations. The case-controls were matched using propensity-score matching and compared to various endpoints. Results Post match, there were 1171 with and without frailty who were undergoing gastrectomy for gastric cancer. Those with frailty had higher mortality (6.83 vs 3.50% p < 0.001, OR 2.02 95% CI 1.37-2.97), length of stay (16.7 vs 12.0d; p < 0.001), and costs ($191,418 vs $131,367; p < 0.001); frail patients also had higher rates of complications including wound complications (3.42 vs 0.

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ABSTRACT:Interpenetrating polymer network (IPN) hydrogels composed of poly(2-ethyl-2-oxazoline) (PEtOz) and chitosan (CS) were prepared with radical polymerization and were characterized for their swelling properties. Sample OC11 (hydrogel weight ratio PEtOz/CS ϭ 1/1) swelled more than samples OC21 (PEtOz/CS ϭ 2/1) and OC31 (PEtOz/CS ϭ3/1), exhibiting a swelling ratio of about 2000 wt % in deionized water; the swelling ratios of the other samples were about 1000 and 700 wt %. The swelling behavior of the IPN hydrogels was observed under various pH and temperature conditions. The swelling ratios of the samples ranged from about 2000 to 6500 wt % at lower pHs, with a maximum swelling ratio of about 6500 wt % in a pH 2 aqueous solution. They exhibited low critical solution temperature behavior, with sample OC31 more sensitive to temperature and sample OC11 more sensitive to pH.