Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization

OBJECTIVES: This study was designed to study the influence of diabetes on the outcome of unstable coronary artery disease (CAD). BACKGROUND: Diabetes mellitus is a major contributor to CAD. Despite improvement in the management of patients with unstable coronary syndromes, this condition is still linked to a substantially increased mortality and morbidity among diabetic patients. Recent evidence advocates early revascularization in unstable coronary syndromes. Diabetic patients subjected to coronary interventions under stable conditions have a higher risk for complications and a more dismal prognosis than nondiabetic subjects. Accordingly, it is of considerable interest to obtain further information regarding the best possible management of diabetic patients with unstable CAD. METHODS: A total of 2158 patients without and 299 with diabetes mellitus were randomized to an early invasive or a noninvasive strategy. The severity of CAD was expressed as the number and extent of vessel involvement. RESULTS: Three-vessel disease was diagnosed in 42% of diabetic and 31% of nondiabetic patients (p = 0.006). The percentages of patients with ST-depression and troponin-T >0.03 microg/l at admission were comparable among diabetic and nondiabetic patients. Mortality and reinfarction after 12 months were more frequent among diabetic than nondiabetic patients in both treatment groups. Diabetes remained a strong independent predictor for death and myocardial infarction in multivariable analysis. The invasive strategy reduced event rate in nondiabetic patients from 12.0% to 8.9% (odds ratio [OR] = 0.72; confidence interval [CI] 0.54 to 0.95; p = 0.019) and in diabetic patients from 29.9% to 20.6% (OR 0.61; CI 0.36 to 1.04; p = 0.066). In a multivariate analysis including the extent of CAD, diabetes remained a strong independent predictor of the combined end point (relative risk [RR] 2.40; CI 1.47 to 3.91; p = 0.0001) and of mortality (RR 5.43; CI 2.09 to 14.12; p = 0.001). CONCLUSIONS: An invasive strategy improved outcome for both diabetic and nondiabetic patients with unstable CAD. However, diabetes mellitus remained an independent and important risk factor for death and myocardial infarction in the invasive group. Thus, factors beyond the extent of flow-limiting coronary lesions are of considerable importance for outcome in diabetic subjects with unstable coronary syndromes.     

Laser explantation of a failing endosseous dental implant

Explantation of failed dental implants has traditionally been performed by mechanical bone removal techniques. The advent of intraoral laser surgery has seen increasing numbers of applications in oral implantology. The technique demonstrates safe and efficient explantation of a failed dental implant using Er,Cr:YSGG laser. Laser assisted explantation of dental implants is a minimally invasive technique providing an alternative to conventional mechanical explantation techniques.     

Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe)

The Strengths and Difficulties Questionnaire (SDQ) is an internationally widely used, brief screening instrument for mental health problems in children and teenagers. The SDQ probes behaviours and psychological attributes reflecting the child's difficulties as well as strengths, and targets hyperactivity/inattention, emotional symptoms, conduct problems, peer problems and prosocial behaviour. Also, the instrument taps the impact aspect, i.e. whether the child is judged to suffer from emotional or behavioural problems severe enough to cause distress or social impairment. Studies of the original English SDQ, as well as of translations into several other languages, attest to a compelling usefulness and validity of the instrument. In this investigation, the adequacy of the Swedish adaptation of the SDQ (SDQ-Swe) was tested in comparisons between parent reports on 5-15-year-old children drawn from a community sample (n=263) and from a child psychiatric sample (n=230). Results showed that the instrument differentiated well between the community and the psychiatric samples, the latter displaying more symptoms, fewer strengths and more social impairment. Moreover, ROC analyses showed satisfactory sensitivity and specificity of the principal scales of the SDQ-Swe at proposed cut-offs. Hence, results showed adequate validity of the SDQ-Swe, suggesting that this new instrument, an instrument in tune with the ideas of contemporary child psychiatry and psychology, is a useful tool for mental health screening in children and adolescents.     

Sequence variation in SORL1 and dementia risk in Swedes

The gene encoding the neuronal sortilin-related receptor SORL1 has been claimed to be associated with Alzheimer's disease (AD) by independent groups and across various human populations. We evaluated six genetic markers in SORL1 in a sample of 1,558 Swedish dementia cases (including 1,270 AD cases) and 2,179 controls. For both single-marker-based and haplotype-based analyses, we found no strong support for SORL1 as a dementia or AD risk-modifying gene in our sample in isolation nor did we observe association with AD/dementia-related traits, including cerebrospinal fluid β-amyloid_1–42, tau levels, or age at onset. However, meta-analyses of markers in this study together with previously published studies on SORL1 encompassing in excess of 13,000 individuals does suggest significant association with AD (best odds ratio?=?1.097; 95% confidence interval?=?1.038–1.158, p?=?0.001). All six markers were significant in meta-analyses and it is notable that they occur in two distinct linkage disequilibrium blocks. These data are consistent with either allelic heterogeneity or the existence of as yet untested functional variants and these will be important considerations in further attempts to evaluate the importance of sequence variation in SORL1 with AD risk.     

A relationship between migraine and biliary tract disorders: findings in two Swedish samples of elderly twins

Nilsson S, Edvinsson L, Malmberg B, Johansson B, Linde M. A relationship between migraine and biliary tract disorders: findings in two Swedish samples of elderly twins.
Acta Neurol Scand: 2010: 122: 286–294.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives – To investigate whether there is a relationship between the clinical occurrence of migraine and biliary tract disorders (BTD) and to study whether there is a genetic influence on such an association. Materials and Methods – The near lifetime morbidity for migraine and BTD was examined in two Swedish twin‐samples: OCTO‐Twin (149 MZ and 202 DZ pairs; 234 men, 468 women; 80 years of age or older at inclusion), and the GENDER study (249 unlike‐sex DZ‐pairs; 70–80 years of age at inclusion). The diagnosis of BTD was established by perusal of medical records from the last twenty years. The diagnosis of migraine was based on iterated questionnaires and personal interviews. Results – The odds ratio (OR) of BTD among OCTO‐Twin subjects suffering from migraine was 3.5 (1.9–6.7) in monozygotic pairs and 1.7 (1.0–2.9) in dizygotic pairs The corresponding figures among the GENDER unlike‐sex DZ‐pairs was 2.7 (1.6–4.5). Migraine was associated with female sex and waist circumference. Conclusions – There is a relationship between the occurrence of migraine and BTD, also when controlling for the fact that both disorders are more frequent in women. The association appears to be partly attributable to genetic influences.