The effect of periodontal treatment on glycemic control in patients with type 2 diabetes mellitus

BACKGROUND, AIMS: This study was designed to explore the effect of periodontal therapy on glycemic control in persons with type 2 diabetes mellitus (DM). METHODS: 36 patients with type 2 DM (treatment group) received therapy for adult periodontitis during an 18-month period. A 36-person control group was randomly selected from the same population of persons with type 2 DM who did not receive periodontal treatment. RESULTS: These groups were well matched for most of the parameters investigated. During the nine-month observation period, there was a 6.7% improvement in glycemic control in the control group when compared to a 17.1% improvement in the treatment group, a statistically significant difference. Several parameters that could confound or moderate this glycemic control were explored. These included the treatment of non-dental infections, weight and medication changes. No moderating effect was associated with any of these variables. However, there were too few subjects in the study to have the statistical power necessary to assess these possible moderators of glycemic control. CONCLUSIONS: We interpret the data in the study to suggest that periodontal therapy was associated with improved glycemic control in persons with type 2 DM.     

Association of incident restless legs syndrome with outcomes in a large cohort of US veterans

Restless legs syndrome is a common sleep disorder, but there is a paucity of large cohort studies examining the association of restless legs syndrome with clinical outcomes, including all‐cause mortality, incident coronary heart disease, stroke and chronic kidney disease. From a nationally representative prospective cohort of over 3 million US veterans [93% male, median follow‐up time of 8.1 years (interquartile range: 7.0–8.5 years)] with baseline estimated glomerular filtration rate ≥60 mL min^?1 1.73 m^?2, a propensity‐matched cohort of 7392 patients was created, and the association between incident restless legs syndrome and the following was examined: (1) all‐cause mortality; (2) incident coronary heart disease; (3) incident strokes; and (4) incident chronic kidney disease defined as estimated glomerular filtration rate <60 mL min^?1 1.73 m^?2. Associations were examined using Cox models. The mean ± SD age of the propensity‐matched cohort at baseline was 59 ± 12 years; 89 and 8% of patients were white and black, respectively; 31% of the patients were diabetic; and the mean baseline estimated glomerular filtration rate was 83.9 ± 15.1 mL min^?1 1.73 m^?2. Propensity matching resulted in a balanced cohort, with the disappearance in baseline differences in comorbidities. Compared with restless legs syndrome‐negative patients, incident restless legs syndrome was associated with 88% higher mortality risk [hazard ratio and 95% confidence interval: 1.88 (1.70–2.08)], and almost four times higher risk of coronary heart disease and stroke [hazard ratio: 3.97 (3.26–4.84) and 3.89 (3.07–4.94), respectively]. The risk of incident chronic kidney disease was also significantly higher in incident restless legs syndrome patients [hazard ratio: 3.17 (2.74–3.66)] compared with restless legs syndrome‐negative counterparts. In this large and contemporary cohort of US veterans, incident restless legs syndrome was associated with higher risk of mortality, incident coronary heart disease, stroke and chronic kidney disease.     

Stakeholders’ Perceptions Regarding the Use of Patient Photographs Integrated with Medical Imaging Studies

Integrating digital facial photographs of pediatric patients as identifiers (ID) with medical imaging (integrated photographic IDs) may increase the detection of mislabeled studies. The purpose of this study was to determine how different stakeholders would receive this novel technology. Parents or guardians of patients in a children’s hospital outpatient radiology department, radiology faculty and residents, and radiology technologists and nurses were asked to complete a survey. The perception about the anticipated use of integrated photographic ID in different clinical scenarios was investigated, and its predictors were determined using logistic regression analysis. Four hundred ninety-eight parents responded (response rate 83 %); 96 and 97 % supported the use of integrated photographic ID, if it improves the radiologist’s imaging interpretation or decreases the rate of mislabeled errors, respectively. Thirty-eight percent were worried that photographic IDs would impact patients’ privacy. Ninety-four percent believed that they should be asked for their consent prior to obtaining their child’s photograph. Seventy-eight radiologists responded (response rate 39 %); 63 and 59 % believed that the use of integrated photographic ID would result in improvement in accurate interpretation of images and identification of mislabeled patient errors, respectively. Forty-nine percent of radiologists had concern that integrated photographic ID would increase interpretation time. Fifty technologists and nurses responded (response rate 59 %); 71 and 73 % supported the technology if it resulted in more acute interpretation of images and identification of mislabeled patients, respectively. A majority of stakeholders support integrated photographic ID in order to improve safety. A majority of parents believe that consent should be obtained.     

Comprehensive characterization of a Canadian cohort of von Hippel-Lindau disease patients

Von Hippel-Lindau disease (VHL) is a heritable condition caused by pathogenic variants in VHL and is characterized by benign and malignant lesions in the central nervous system (CNS) and abdominal viscera. Due to its variable expressivity, existing efforts to collate VHL patient data do not adequately capture all VHL manifestations. We developed a comprehensive and standardized VHL database in the web-based application, REDCap, that thoroughly captures all VHL manifestation data. As an initial trial, information from 86 VHL patients from the University Health Network/Hospital for Sick Children was populated into the database. Analysis of this cohort showed missense variants occurring with the greatest frequency, with all variants localizing to the α- or β-domains of VHL. The most prevalent manifestations were central nervous system (CNS), renal, and retinal neoplasms, which were associated with frameshift variants and large deletions. We observed greater age-related penetrance for CNS hemangioblastomas with truncating variants compared to missense, while the reverse was true for pheochromocytomas. We demonstrate the utility of a comprehensive VHL database, which supports the standardized collection of clinical and genetic data specific to this patient population. Importantly, we expect that its web-based design will facilitate broader international collaboration and lead to a better understanding of VHL.     

Uncemented total hip arthroplasty with subtrochanteric derotational osteotomy for severe femoral anteversion.

Total hip joint arthroplasty (THA) in the presence of severe femoral anteversion (>50 degrees) is technically demanding. This problem is often encountered in patients with osteoarthritis secondary to hip joint dysplasia or congenital dislocation. We describe a method of THA in which an uncemented femoral prosthesis is used in conjunction with subtrochanteric derotational osteotomy. This technique allows the restoration of the normal proximal femoral anatomy, including the abductor muscle lever arm without resorting to greater trochanteric transfer. Correction of the excessive femoral anteversion avoids the tendency for postoperative anterior instability. The osteotomy site may also serve as the site for femoral shortening or angular correction when required, which preserves the normal femoral flare. The prostheses used were custom CAD/CAM (computer-assisted design/computer-assisted manufacturer) in design and had the following features: a close intramedullary proximal fit, with collar, lateral flare, and hydroxyapatite coating to achieve early proximal fixation, and longitudinally cutting fluted stem to provide immediate rotational stability across the osteotomy site. Although we used CAD/CAM custom prostheses, off-the-shelf uncemented hip prostheses with similar design features have become available. We report on 7 patients who underwent THA using this technique. The average patient age was 49 years (range, 34-61 years) with a mean follow-up period of 31 months (range, 16-60 months). To date, all cases have had a satisfactory outcome with evidence of union at the osteotomy site. Harris hip scores improved from an average of 44 preoperatively to 91 by the end of follow-up period. One case was complicated by delayed union at the osteotomy site, which was successfully corrected with bone grafting and temporary plate stabilization.     

A Novel Additive Manufacturing Method of Cellulose Gel

Screen-additive manufacturing (SAM) is a potential method for producing small intricate parts without waste generation, offering minimal production cost. A wide range of materials, including gels, can be shaped using this method. A gel material is composed of a three-dimensional cross-linked polymer or colloidal network immersed in a fluid, known as hydrogel when its main constituent fluid is water. Hydrogels are capable of absorbing and retaining large amounts of water. Cellulose gel is among the materials that can form hydrogels and, as shown in this work, has the required properties to be directly SAM, including shear thinning and formation of post-shearing gel structure. In this study, we present the developed method of SAM for the fabrication of complex-shaped cellulose gel and examine whether successive printing layers can be completed without delamination. In addition, we evaluated cellulose SAM without the need for support material. Design of Experiments (DoE) was applied to optimize the SAM settings for printing the novel cellulose-based gel structure. The optimum print settings were then used to print a periodic structure with micro features and without the need for support material.     

Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland

Background: Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known. Methods: Over a 4‐year period, all ischaemic stroke patients admitted within 24 h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short‐term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI). Results: Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS ≤ 2) at 7 days and 3 months was more frequent in PI than in BI. Conclusion: We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained.     

One size fits all: or horses for courses? Recovery-based care in specialist mental health services

Introduction

The ??recovery approach?? to the management of severe mental health problems has become a guiding vision of service provision amongst many practitioners, researchers, and policy makers as well as service users.

Method

This qualitative pilot study explored the meaning of ??recovery?? with users of three specialist mental health services (eating disorders, dual diagnosis, and forensic) in 18 semi-structured interviews.

Results

The relevance of themes identified in mainstream recovery literature was confirmed; however, the interpretation and relative weight of these themes appeared to be affected by factors that were specific to the diagnosis and treatment context. ??Clinical?? recovery themes were also seen as important, as were aspects of care that reflect core human values, such as kindness.