Biomechanics and biology of external fixation of distal radius fractures

External fixation is a versatile and useful tool for management of complex fractures. There is little to choose between the various types of commercially available fixators, and it is important to use one that allows the surgeon adequate versatility and follows sound biomechanical principles. Ligamentotaxis can be used effectively to reduce the most difficult fractures; however, over-distraction and prolonged traction are harmful and should be avoided. Certain types of fractures do not respond to treatment with ligamentotaxis alone and require adjunctive treatment, such as limited internal fixation. A single K-wire significantly adds to the stability of fixation and should be considered in all cases. Understanding the basic mechanical principles and respect for pin-bone biology allow for successful use of external fixation with minimal complications.     

Waist circumference criteria for the diagnosis of abdominal obesity are not applicable uniformly to all populations and ethnic groups

Determination of cutoff points of waist circumference is of paramount importance for prevention, optimum management, and prognostication of obesity, the metabolic syndrome, type 2 diabetes mellitus, and coronary heart disease. Heterogeneity of composition of abdominal tissues, in particular adipose tissue and skeletal muscle, and their location-specific and changing relations with metabolic factors and cardiovascular risk factors in different ethnic groups do not allow a simple definition of abdominal obesity that could be applied uniformly. In particular, Asians appear to have higher morbidity at lower cutoff points for waist circumference than do white Caucasians. International health agencies that deal with obesity (World Health Organization, International Obesity Task Force) should take cognizance of these data and consider formulating new cutoff points for waist circumference to define abdominal obesity for Asian populations.     

VHL-mediated hypoxia regulation of cyclin D1 in renal carcinoma cells

Renal cell carcinoma is associated with mutation of the von Hippel-Lindau (VHL) tumor suppressor gene. Cell lines derived from these tumors cannot exit the cell cycle when deprived of growth factors, and the ability to exit the cell cycle can be restored by the reintroduction of wild-type protein VHL (pVHL). Here, we report that cyclin D1 is overexpressed and remains inappropriately high in during contact inhibition in pVHL-deficient cell lines. In addition, hypoxia increased the expression of cyclin D1 specifically in pVHL-negative cell lines into which pVHL expression was restored. Hypoxic-induction of cyclin D1 was not observed in other pVHL-positive cell lines. This suggests a model whereby in some kidney cell types, pVHL may regulate a proliferative response to hypoxia, whereas the loss of pVHL leads to constitutively elevated cyclin D1 and abnormal proliferation under normal growth conditions.     

Extending iterative matching methods: an approach to improving covariate balance that allows prioritisation

Comparative effectiveness studies can identify the causal effect of treatment if treatment is unconfounded with outcome conditional on a set of measured covariates. Matching aims to ensure that the covariate distributions are similar between treatment and control groups in the matched samples, and this should be done iteratively by checking and improving balance. However, an outstanding concern facing matching methods is how to prioritise competing improvements in balance across different covariates. We address this concern by developing a ??loss function?? that an iterative matching method can minimise. Our ??loss function?? is a transparent summary of covariate imbalance in a matched sample and follows general recommendations in prioritising balance amongst covariates. We illustrate this approach by extending Genetic Matching (GM), an automated approach to balance checking. We use the method to reanalyse a high profile comparative effectiveness study of right heart catheterisation. We find that our loss function improves covariate balance compared to a standard GM approach, and to matching on the published propensity score.     

Control of blood pressure and other cardiovascular risk factors at different practice settings: outcomes of care provided to diabetic women compared to men

Cardiovascular disease (CVD) is the major cause of morbidity and mortality in diabetes. To determine the proportion of patients who met the American Diabetes Association guidelines for control of CVD risk factors and to assess the achievement of these guidelines in women compared with men, we conducted a cross-sectional study of 3678 diabetic cohorts followed at seven medical centers, two Veteran Administration hospitals, three urban clinics, and two suburban clinics. Overall, 28% met the target blood pressure of <130/80 mm Hg, 48.8% achieved a goal low-density lipoprotein cholesterol of <100 mg/dL, and 35.8% had hemoglobin A1c of <7%. Gender comparisons of 2788 diabetic patients at urban and suburban centers showed that women had a lower percentage of low-density lipoprotein cholesterol <100 mg/dL (45.8 vs. 51.3, p<0.01) and a lower percentage of screening for retinopathy (54 vs. 60, p<0.01) and nephropathy (37 vs. 49, p<0.01). However, overall there were no gender differences in the percentage of patients who achieved a goal blood pressure <130/80 mm Hg or hemoglobin A1c <7%. Control of blood pressure and other CVD risk factors in diabetic patients was largely suboptimal, especially for diabetic women. These observations underscore the need for better strategies for control of CVD risk in the diabetic population in general, and women in particular.     

Functional and Esthetic Rehabilitation in a Partially Edentulous Patient: A Case Report

A young male patient reported with forwardly placed mandible and partially edentulous upper and lower jaws. Patient’s chief concern was towards his abnormal facial profile and difficulty in mastication. This case report describes various procedures performed to rehabilitate the patient functionally and esthetically. The treatment plan included Onlay bone grafting of mandible using iliac crest, body osteotomy of edentulous mandible and implant retained overdenture.     

Awareness About Needle Stick Injures and Sharps Disposal: A Study Conducted at Army College of Dental Sciences

Background

The present study aims to assess the knowledge and attitude about needle stick injuries and sharps disposal.

Methods

A self designed questionnaire of 15 questions was handed out to 200 participants including undergraduate students (group 1), postgraduate students (group 2), faculty members (group 3) and auxiliary staff members (group 4). The data was collected and analyzed using Chi square test.

Results

Sixty-one percent of total participants reported of experiencing needle stick injury and 25.5 % knew that there could be several causes for this. Only 22 % of total population studied got the source tested. Immunization status of group 4 was very low and they also lacked the knowledge of sharps disposal and hepatitis C being spread by needle stick injuries. 57 % participants confirmed that there was no reporting facility and 66 % were not familiar with the guidelines of reporting.

Conclusions

There is a definite scope of improvement in terms of reporting and prevention of needle stick injuries. There is a need to improve knowledge and awareness of dental health care workers about the post exposure protocol.