Cognitive Decline and Oral Health in Middle-aged Adults in the ARIC Study

Even before dementia becomes apparent, cognitive decline may contribute to deterioration in oral health. This cohort study of middle-aged adults evaluated associations of six-year change in cognitive function with oral health behaviors and conditions in the Atherosclerosis Risk in Communities (ARIC) study. Cognitive function was measured at study visits in 1990-1992 and 1996-1998 with three tests: (a) Delayed Word Recall (DWR), (b) Digit Symbol Substitution (DSS), and (c) Word Fluency (WF). Cognitive decline scores were computed as ‘studentized’ residuals of 1996-1998 scores regressed against 1990-1992 scores. In 1996-1998, 10,050 participants answered dental screening questions, and 5,878 of 8,782 dentate participants received a comprehensive oral examination. Multiple regression models used cognitive change to predict oral health behaviors and conditions with adjustment for covariates. In the fully adjusted models, greater decline in all three measures of cognitive function was associated with increased odds of complete tooth loss. Greater decline in DSS and WF scores was associated with infrequent toothbrushing. Decline in WF scores was also associated with higher plaque levels. In these middle-aged adults, six-year cognitive decline was modestly associated with less frequent toothbrushing, plaque deposit, and greater odds of edentulism, but not with other oral behaviors or diseases

Influence of human leukocyte antigen (HLA) alleles and killer cell immunoglobulin-like receptors (KIR) types on heparin-induced thrombocytopenia (HIT)

Objectives Heparin-induced thrombocytopenia (HIT) is an unpredictable, life-threatening, immune-mediated reaction to heparin. Variation in human leukocyte antigen (HLA) genes is now used to prevent immune-mediated adverse drug reactions. Combinations of HLA alleles and killer cell immunoglobulin-like receptors (KIR) are associated with multiple autoimmune diseases and infections. The objective of this study is to evaluate the association of HLA alleles and KIR types, alone or in the presence of different HLA ligands, with HIT.\ud Methods HIT cases and heparin-exposed controls were identified in BioVU, an electronic health record coupled to a DNA biobank. HLA sequencing and KIR type imputation using Illumina® OMNI-Quad data were performed. Odds ratios for HLA alleles and KIR types and HLA*KIR interactions using conditional logistic regressions were determined in the overall population and by race/ethnicity. Analysis was restricted to KIR types and HLA alleles with a frequency greater than 0.01. P values for HLA and KIR association were corrected using a false discovery rate (FDR) q<0.05 and HLA*KIR interactions were considered significant at p<0.05. Results Sixty-five HIT cases and 350 matched controls were identified. No statistical differences in baseline characteristics were observed between cases and controls. The HLA-DRB3*01:01 allele was significantly associated with HIT in the overall population (odds ratio 2.81[1.57-5.02], p=2.1x10-4, q=0.02) and in individuals with European ancestry, independent of other alleles. No KIR types were associated with HIT, although a significant interaction was observed between KIR2DS5 and the HLA-C1 KIR binding group (p=0.03). Conclusions The HLA-DRB3*01:01 allele was identified as a potential risk factor for HIT. This class II HLA gene and allele represent biologically plausible candidates for influencing HIT pathogenesis. We found limited evidence of the role of KIR types in HIT pathogenesis. Replication and further study of the HLA-DRB3*01:01 association is necessary

The ARIC (Atherosclerosis Risk In Communities) Study: JACC Focus Seminar 3/8

ARIC (Atherosclerosis Risk In Communities) initiated community-based surveillance in 1987 for myocardial infarction and coronary heart disease (CHD) incidence and mortality and created a prospective cohort of 15,792 Black and White adults ages 45 to 64 years. The primary aims were to improve understanding of the decline in CHD mortality and identify determinants of subclinical atherosclerosis and CHD in Black and White middle-age adults. ARIC has examined areas including health disparities, genomics, heart failure, and prevention, producing more than 2,300 publications. Results have had strong clinical impact and demonstrate the importance of population-based research in the spectrum of biomedical research to improve health

N and C Isotope Variations Along an Extreme Eutrophication and Salinity Gradient in the Coorong Lagoon, South Australia

The Coorong Lagoon is a unique hydrological and depositional system at the terminus of the Murray–Darling Basin, the largest river system in Australia. It exhibits large salinity, nutrient, and organic matter gradients, providing a modern analogue to study and validate the use of δ15N and δ13C as tracers of past and contemporary geochemical cycles in estuarine environments. To this end, water and surface sediment samples were analyzed for particulate organic nitrogen (PON) and carbon (POC) concentrations, and the respective δ15N and δ13C signatures of particulate nitrogen and carbon. PON and POC exhibited positive relationships to chlorophyll-a, indicating the dominance of phytoplankton production upon suspended organic matter. There was also a general trend of increasing δ15N of PON (δ15NPON) values and decreasing δ13C of particulate carbon (δ13CPC) values with increasing salinity and eutrophication in the restricted South Lagoon. In a multiple linear regression for δ15NPON, the best two predictors in combination are PON and C:N molar ratio, highlighting the importance of productivity and the type or source of organic matter. For δ13CPC, the best two predictors are total dissolved phosphorus and latitude, suggesting influences from productivity and proximity to the ocean. Sediment δ15N values across the Coorong Lagoon overlap with the δ15NPON in the water column, suggesting that PON derived from algal material represents the main source of nitrogen to lagoon sediments. We hypothesize that limited N loss via denitrification leads to PON being recycled almost exclusively to ammonium, due to low rates of nitrification and dominance of dissimilatory nitrate reduction to ammonium (DNRA). We propose that preferential volatilization of 14N in ammonia increases the δ15N of ammonium assimilated by phytoplankton, thereby increasing the δ15N within suspended organic matter and surface sediment in the South Lagoon. By contrast, the gradient exhibited in δ13CPC data was countered by a relatively constant sedimentary organic carbon δ13C. Data from the Coorong, therefore, suggest that δ15N values in sediments can be used to infer palaeoproductivity in this hypereutrophic and hypersaline depositional environment, however, the measured δ13CPC may be influenced by δ13CDIC or preferential loss of 13C during sedimentation that alter the sedimentary δ13C record of organic carbon.Stacey C. Priestley, Jonathan Tyler, Savannah R. Liebelt, Luke M. Mosley, Wei Wen Wong, Yuexiao Shao, Zara Woolston, Mark Farrell, David T. Welsh, Justin D. Brookes, Alan S. Collins, Chris Keneally, and Juraj Farka

Heart Failure Stages among Older Adults in the Community: The Atherosclerosis Risk in Communities Study

Background: Although heart failure (HF) disproportionately affects older adults, little data exist regarding the prevalence of American College of Cardiology/American Heart Association HF stages among older individuals in the community. Additionally, the role of contemporary measures of longitudinal strain and diastolic dysfunction in defining HF stages is unclear. Methods: HF stages were classified in 6118 participants in the Atherosclerosis Risk in Communities study (67-91 years of age) at the fifth study visit as follows: A (asymptomatic with HF risk factors but no cardiac structural or functional abnormalities), B (asymptomatic with structural abnormalities, defined as left ventricular hypertrophy, dilation or dysfunction, or significant valvular disease), C1 (clinical HF without prior hospitalization), and C2 (clinical HF with earlier hospitalization). Results: Using the traditional definitions of HF stages, only 5% of examined participants were free of HF risk factors or structural heart disease (Stage 0), 52% were categorized as Stage A, 30% Stage B, 7% Stage C1, and 6% Stage C2. Worse HF stage was associated with a greater risk of incident HF hospitalization or death at a median follow-up of 608 days. Left ventricular (LV) ejection fraction was preserved in 77% and 65% in Stages C1 and C2, respectively. Incorporation of longitudinal strain and diastolic dysfunction into the Stage B definition reclassified 14% of the sample from Stage A to B and improved the net reclassification index (P=0.028) and integrated discrimination index (P=0.016). Abnormal LV structure, systolic function (based on LV ejection fraction and longitudinal strain), and diastolic function (based on e', E/e', and left atrial volume index) were each independently and additively associated with risk of incident HF hospitalization or death in Stage A and B participants. Conclusions: The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared with previous reports in younger community-based samples. LV ejection fraction is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HF with preserved LV ejection fraction in the elderly. LV diastolic function and longitudinal strain provide incremental prognostic value beyond conventional measures of LV structure and LV ejection fraction in identifying persons at risk for HF hospitalization or death

Predicting stroke through genetic risk functions: the CHARGE Risk Score Project.

BACKGROUND AND PURPOSE: Beyond the Framingham Stroke Risk Score, prediction of future stroke may improve with a genetic risk score (GRS) based on single-nucleotide polymorphisms associated with stroke and its risk factors. METHODS: The study includes 4 population-based cohorts with 2047 first incident strokes from 22,720 initially stroke-free European origin participants aged ≥55 years, who were followed for up to 20 years. GRSs were constructed with 324 single-nucleotide polymorphisms implicated in stroke and 9 risk factors. The association of the GRS to first incident stroke was tested using Cox regression; the GRS predictive properties were assessed with area under the curve statistics comparing the GRS with age and sex, Framingham Stroke Risk Score models, and reclassification statistics. These analyses were performed per cohort and in a meta-analysis of pooled data. Replication was sought in a case-control study of ischemic stroke. RESULTS: In the meta-analysis, adding the GRS to the Framingham Stroke Risk Score, age and sex model resulted in a significant improvement in discrimination (all stroke: Δjoint area under the curve=0.016, P=2.3×10(-6); ischemic stroke: Δjoint area under the curve=0.021, P=3.7×10(-7)), although the overall area under the curve remained low. In all the studies, there was a highly significantly improved net reclassification index (P&lt;10(-4)). CONCLUSIONS: The single-nucleotide polymorphisms associated with stroke and its risk factors result only in a small improvement in prediction of future stroke compared with the classical epidemiological risk factors for stroke

The new Kr-86 excess ice core proxy for synoptic activity: West Antarctic storminess possibly linked to Intertropical Convergence Zone (ITCZ) movement through the last deglaciation

Here we present a newly developed ice core gas-phase proxy that directly samples a component of the large-scale atmospheric circulation: synoptic-scale pressure variability. Surface pressure changes weakly disrupt gravitational isotopic settling in the firn layer, which is recorded in krypton-86 excess (86Krxs). The 86Krxs may therefore reflect the time-averaged synoptic pressure variability over several years (site “storminess”), but it likely cannot record individual synoptic events as ice core gas samples typically average over several years. We validate 86Krxs using late Holocene ice samples from 11 Antarctic ice cores and 1 Greenland ice core that collectively represent a wide range of surface pressure variability in the modern climate. We find a strong spatial correlation (, p<0.01) between site average 86Krxs and time-averaged synoptic variability from reanalysis data. The main uncertainties in the analysis are the corrections for gas loss and thermal fractionation and the relatively large scatter in the data. Limited scientific understanding of the firn physics and potential biases of 86Krxs require caution in interpreting this proxy at present. We show that Antarctic 86Krxs appears to be linked to the position of the Southern Hemisphere eddy-driven subpolar jet (SPJ), with a southern position enhancing pressure variability. We present a 86Krxs record covering the last 24 kyr from the West Antarctic Ice Sheet (WAIS) Divide ice core. Based on the empirical spatial correlation of synoptic activity and 86Krxs at various Antarctic sites, we interpret this record to show that West Antarctic synoptic activity is slightly below modern levels during the Last Glacial Maximum (LGM), increases during the Heinrich Stadial 1 and Younger Dryas North Atlantic cold periods, weakens abruptly at the Holocene onset, remains low during the early and mid-Holocene, and gradually increases to its modern value. The WAIS Divide 86Krxs record resembles records of monsoon intensity thought to reflect changes in the meridional position of the Intertropical Convergence Zone (ITCZ) on orbital and millennial timescales such that West Antarctic storminess is weaker when the ITCZ is displaced northward and stronger when it is displaced southward. We interpret variations in synoptic activity as reflecting movement of the South Pacific SPJ in parallel to the ITCZ migrations, which is the expected zonal mean response of the eddy-driven jet in models and proxy data. Past changes to Pacific climate and the El Niño–Southern Oscillation (ENSO) may amplify the signal of the SPJ migration. Our interpretation is broadly consistent with opal flux records from the Pacific Antarctic zone thought to reflect wind-driven upwelling. We emphasize that 86Krxs is a new proxy, and more work is called for to confirm, replicate, and better understand these results; until such time, our conclusions regarding past atmospheric dynamics remain speculative. Current scientific understanding of firn air transport and trapping is insufficient to explain all the observed variations in 86Krxs. A list of suggested future studies is provided

Surface and subsurface flow in eucalyptus plantations in north-central Portugal

In the Baixo Vouga region of north-central Portugal, forests occupy half of the territory, of which two thirds are Eucalypts plantations. The hydrological implications of this large-scale introduction of eucalypt are unknown and the aim of this exploratory study, realized in the Caramulo Mountains, was to describe overland flow (OLF), subsurface flow (SSF) and stream flow (Q) in a catchment dominated by Eucalyptus plantations. The main conclusions are that annual OLF rate is low, spatially heterogeneous between 0.1% and 6% and concentrated during the wet season as saturation excess, particularly as return flow. Infiltration-excess OLF due to the strong soil water repellence (SWR) is dominant during dry season, but produces residual runoff amount. SSF is the principal mechanism of runoff formation. It originates from matrix flow and pipe flow at the soil-bedrock interface, principally during the wet season. Matrix flow is correlated with soil moisture (SM) content, with a threshold of 25 %. Pipe flow starts with saturation of soil bottom but without saturation of the entire soil profile, due to a large network of macropores. Stream flow response is highly correlated with matrix flow behaviour in timing and intensity. SWR induces a very patchy moistening of the soil, concentrates the fluxes and accelerates them almost 100 times greater than normal percolation of the water in the matrix

Genome-wide meta-analyses reveal novel loci for verbal short-term memory and learning

Understanding the genomic basis of memory processes may help in combating neurodegenerative disorders. Hence, we examined the associations of common genetic variants with verbal short-term memory and verbal learning in adults without dementia or stroke (N = 53,637). We identified novel loci in the intronic region of CDH18, and at 13q21 and 3p21.1, as well as an expected signal in the APOE/APOC1/TOMM40 region. These results replicated in an independent sample. Functional and bioinformatic analyses supported many of these loci and further implicated POC1. We showed that polygenic score for verbal learning associated with brain activation in right parieto-occipital region during working memory task. Finally, we showed genetic correlations of these memory traits with several neurocognitive and health outcomes. Our findings suggest a role of several genomic loci in verbal memory processes

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele