Oral health related quality of life in pregnant and post partum women in two social network domains; predominantly home-based and work-based networks

Background  

Individuals connected to supportive social networks have better general and oral health quality of life. The objective of this study was to assess whether there were differences in oral health related quality of life (OHRQoL) between women connected to either predominantly home-based and work-based social networks.     

Prolonged exercise increases serum insulin-like growth factor-binding protein concentrations

We studied the response of serum 34K insulin-like growth factor-binding protein (IGF-BP) to two types of prolonged exercise. In the first study, 11 normal men performed cycle ergometer exercise, after an overnight fast, for 3 h at the intensity corresponding to 45-50% of their maximal aerobic power. After the exercise, the mean serum IGF-BP concentration was 4.9-fold higher than the baseline level (P less than 0.01), while the IGF-I concentration did not change. Resting for the same time period resulted in a 38% fall in the serum IGF-BP level (P less than 0.01). In the second study, 10 normal men and 8 type 1 diabetic men exercised, on the average, for 7.5 h in a 75-km cross-country ski race. The mean serum IGF-BP concentration increased 5.4-fold (P less than 0.01) in the normal men and 4.2-fold (P less than 0.01) in the diabetic men. The serum IGF-I concentration decreased by 19% and 21% in the normal and diabetic men, respectively (P less than 0.01). After completion of the ski race, the serum insulin and IGF-BP levels (r = -0.70; P less than 0.05), and serum IGF-I and IGF-BP levels (r = -0.72; P less than 0.05) were inversely correlated in the normal men. No such correlations were found in the diabetic men. We conclude that 1) long term exercise increases serum IGF-BP concentrations in both normal and type 1 diabetic men; and 2) the increases are inversely related to alterations in serum IGF-I and insulin concentrations in normal men. These data suggest that IGF-BP may be involved in regulation of the biological action of IGF-I during prolonged exercise.     

Severity, duration, and mechanisms of insulin resistance during acute infections

Acute infections provoke insulin resistance. These experiments were designed to study the severity, duration, and mechanisms of insulin resistance caused by acute infections. First, we studied eight patients [mean age, 29 +/- 11 (+/- SD) yr; body mass index, 23 +/- 2 kg/m2] with acute viral or bacterial infections during the acute stage of their infection and 1-3 months after recovery. The rate of glucose infusion required to maintain normoglycemia during hyperinsulinemia (approximately 500 pmol/L) was used as a measure of insulin action. During infection, the glucose requirements in the patients [21 +/- 2 (+/- SE) mumol/kg.min] were 52% less than those in weight- and age-matched normal subjects (44 +/- 2 mumol/kg.min; P less than 0.001). Compared to data from a large group of normal subjects, the resistance to insulin during infection corresponded to that predicted for a weight-matched 84-yr-old normal person or an age-matched obese person with a body mass index of 37 kg/m2. One to 3 months after recovery, the patients' glucose requirements were still significantly lower (37 +/- 3 mumol/kg.min; P less than 0.02) than those in matched normal subjects. To assess the mechanism of insulin resistance, seven additional patients were studied during the acute stage of infection using a low dose insulin infusion (plasma insulin, 215 pmol/L) combined with a [3-3H]glucose infusion and indirect calorimetry. Again, the glucose requirements were 59% lower in the patients (14 +/- 2 mumol/kg.min) than in matched normal subjects (34 +/- 2 mumol/kg.min; P less than 0.001). This decrease was due to a defect in glucose utilization (18 +/- 2 vs. 37 +/- 1 mumol/kg.min; P less than 0.001, patients vs. normal subjects) rather than impaired suppression of glucose production (4 +/- 1 vs. 3 +/- 1 mumol/kg.min, respectively). Total carbohydrate oxidation rates were similar in both groups (16 +/- 2 vs. 14 +/- 1 mumol/kg.min, respectively), whereas the apparent glucose storage was neglible in the patients (2 +/- 1 mumol/kg.min) compared to that in normal subjects (22 +/- 2 mumol/kg.min; P less than 0.001). We conclude that acute infections induce severe and long-lasting insulin resistance, which is localized to glucose-utilizing pathways. The rate of carbohydrate oxidation is normal during infections, whereas the rate of nonoxidative glucose disposal, as determined by indirect calorimetry, is nearly zero. The apparent blockade in glucose storage could result from diminished glycogen synthesis, accelerated glycogenolysis, or both.     

No association between retinopathy and insulin resistance in type 1 diabetes

Intact endothelial cell function has been suggested to be important for insulin action. An association between retinopathy and insulin resistance has been found in type 2 diabetes. To evaluate, whether insulin resistance is related to retinopathy in insulin dependent diabetes, we examined 36 type 1 diabetic patients with various degrees of retinopathy: 7 patients had proliferative, 15 had background and 14 patients had no retinopathy. The three groups were matched for age, sex, body weight and insulin dose. Compared with patients with no retinopathy, those with proliferative retinopathy had a longer (P less than 0.05) duration of diabetes (13 +/- 3 vs 22 +/- 3 years for no vs proliferative retinopathy), and higher (P less than 0.05) serum creatinine (74 +/- 4 vs 97 +/- 8 mumol/l), triglyceride (0.69 +/- 0.04 vs 1.02 +/- 0.17 mmol/l) and diastolic blood pressure (77 +/- 3 vs 90 +/- 10 mmHg) levels. The rate of insulin-mediated glucose metabolism (1 mU euglycaemic insulin clamp) was virtually identical in each diabetic group (4.80 +/- 0.42, 4.90 +/- 0.36 and 4.98 +/- 0.74 mg/kg/min) and 40% below that in 8 matched normal subjects (7.53 +/- 0.53 mg/kg/min, P less than 0.001). In conclusion, proliferative retinopathy is related to long duration of diabetes, incipient nephropathy and hypertension. Insulin resistance characterizes the majority of patients with type 1 diabetes but is unrelated to retinopathy.     

Type 2 Diabetes and Risk of Rupture of Saccular Intracranial Aneurysm in Eastern Finland

OBJECTIVE

Type 2 diabetes is a risk factor for other forms of stroke, but its association with subarachnoid hemorrhage (SAH) from ruptured saccular intracranial aneurysm (sIA) has remained unclear.

RESEARCH DESIGN AND METHODS

Kuopio Intracranial Aneurysm Database (www.uef.fi/ns) includes all ruptured and unruptured sIA cases from a defined catchment population in eastern Finland since 1980. We compared the age-adjusted incidences of type 2 diabetes in 1,058 ruptured and 484 unruptured sIA patients during 1994–2008, using the national registry of prescribed medicine purchases.

RESULTS

Of the 1,058 ruptured sIA patients, 43% were males and 57% females, with a median age at rupture of 51 and 56 years, respectively. From 1994 to 2008 or until death, 9% had been prescribed antidiabetes medication (ADM) with a median starting age of 58 years for males and 66 years for females. Of the 484 unruptured sIA patients, 44% were males and 56% females, with a median age at the diagnosis of 53 and 55 years, respectively, and 9% had used ADM, with a median starting age of 61 years for males and 66 years for females. The incidence of type 2 diabetes was highest in the age-group 60–70 years, with no significant differences between the ruptured and unruptured sIA patients.

CONCLUSIONS

Our study suggests that type 2 diabetes does not increase the risk of rupture of sIA, which is by far the most frequent cause of nontraumatic SAH.Aneurysmal subarachnoid hemorrhage (SAH) is a devastating form of stroke that affects primarily the working-age population (1). In ~95% of cases, SAH is caused by the rupture of a saccular intracranial aneurysm (sIA) at the fork of intracranial extracerebral arteries in contrast to their infrequent fusiform, mycotic, and traumatic aneurysms. Some 2% of the general population develops sIAs (2–3) during life, but most do not rupture, as the general annual incidence of SAH is 4–7 per 100,000 (4–5). The sIA disease is a complex trait, affected by genomic (6–8) and acquired risk factors (3), the mechanisms of which in the formation, progress, and rupture of sIA pouches are poorly understood. Risk factors include age, female sex, smoking, hypertension, and excess drinking (3), and at least 10% of ruptured sIA patients have a family history (9–12). In a genome-wide association study, susceptibility loci at 2q33.1, 8q11.23, and 9p21.3 have been identified in Finnish subjects (7).Type 2 diabetes is a complex trait affecting the arterial wall through several different mechanisms (13–16). Type 2 diabetes is a well-established risk factor for brain infarction and may predispose to intracerebral hemorrhage (17–19). Instead, the association between type 2 diabetes and sIA disease has remained unclear. Three recent studies (20–22) and our present review of the literature suggest that diabetes is a protecting factor for rupture of sIA (Fig. 1A) (23–29). Both type 2 diabetes and sIA disease are associated with the 9p21.3 locus (6–8,30,31), although not with the same LD block, but they do not seem to share other loci in genome-wide association studies.

Table 1

Previous studies on the association of diabetes and intracranial aneurysm disease* since 2001Open in a separate windowOpen in a separate windowFigure 1A: Review of the literature of the association of diabetes and SAH in case-control studies published 2001–2012. The horizontal lines represent the 95% CIs of the OR or risk ratios (RRs). The size of the black box indicates the relative effect on the final fixed-effect estimate. The x-axis is logarithmic. B: Incidence of type 2 diabetes in 1,058 ruptured (aneurysmal SAH) and 484 unruptured sIA patients by age-group and 95% CIs.Kuopio Intracranial Aneurysm Database (www.uef.fi/ns) contains all cases of unruptured and ruptured sIAs admitted to the Kuopio University Hospital (KUH) from a defined eastern Finnish catchment population since 1980 (11,12). We have studied the phenotype (11), familial form (2,9), risk factors (32), outcome (12,33), concomitant diseases (12), and genomics of sporadic and familial sIA disease (6–8,34). Here, we investigated retrospectively whether type 2 diabetes predisposes to sIA rupture by comparing 1,058 ruptured sIA patients with 484 unruptured sIA patients with first diagnosis between 1995 and 2007. In this study, we tested the hypothesis that arterial long-term effects of type 2 diabetes predispose to the rupture of the sIA wall rather than the formation of the sIA pouch. We also performed a review of the literature of the published cohorts to summarize the previous data on the association of type 2 diabetes and sIA disease.     

Changes in muscle glucose metabolism in type 1 diabetes

Patients with type 1 diabetes are characterized by an average 40% reduction in the insulin sensitivity. In newly diagnosed patients, insulin resistance is due to insulin deficiency and its metabolic consequences. After the beginning of insulin therapy, insulin sensitivity transiently improves, but deteriorates again after 6-9 months of insulin therapy. Insulin resistance is mainly due to a reduction in glucose uptake by muscle tissue. There are similar relative reductions in both oxidative and nonoxidative glucose disposal. When glucose disposal is determined under similar plasma glucose and insulin concentrations, glucose oxidation, the activity of pyruvate dehydrogenase and glycogen synthase are all reduced. If glucose disposal rate in diabetic patients is normalized by glucose mass action, both oxidative and nonoxidative glucose disposal and glycogen synthase activity become normal. As the normalization of glucose disposal occurs in the face of unchanged muscle glucose-6-phosphate concentrations, this suggest that reduced glucose disposal is secondary to reduced glucose transport in type 1 diabetes.     

Prognostic Significance of p53 Expression in Ovarian Granulosa Cell Tumors

Objective.The purpose of the study was to investigate the significance of p53 expression for the prognosis in patients with ovarian granulosa cell tumors (GCT).Methods.The records of 30 patients operated on for GCT at Tampere University Hospital, Finland, were reviewed. The mean age at the time of the diagnosis was 55 years. Twenty-one of the tumors were of FIGO stage I, three were of stage II, three were of stage III, and three were of stage IV. Paraffin-embedded tumor specimens were analyzed by immunohistochemistry for expression of mutated p53 protein and by flow cytometry.Results.Eleven tumors were positive for p53 and 19 were negative. The median crude survival of p53-negative patients was 10 times that of p53-positive ones (210 months vs 21 months,P= 0.037, log-rank test). The association between p53 immunoreactivity and stage was statistically significant (P= 0.026 Pearson χ²test), while there was no association between p53 expression and DNA ploidy or S-phase fraction.Conclusion.Although the results should be considered as preliminary, expression of mutated p53 in ovarian granulosa cell tumors seems to be associated with unfavorable prognosis.     

A 1-year follow-up of low birth weight infants with and without bronchopulmonary dysplasia: health, growth, clinical lung disease, cardiovascular and neurological sequelae.

A cohort of 86 low birth weight (LBW infants (< 1751 g) including 23 subjects with bronchopulmonary dysplasia (BPD) and 23 matched controls without BPD were checked up at corrected ages of 1, 2, 4, 6, 8 and 12 months. Thirty-six of the subjects were re-hospitalized, mostly because of infections, there being no significant difference in the number of hospitalizations between BPD cases and their controls. Delayed growth was frequent, but a catch-up growth was seen. Eighteen of the subjects (5 with BPD and 7 of controls) were of height below 2 SD at a corrected age of 12 months. Twenty-four (14 with BPD and 3 controls) had persistent respiratory symptoms during the follow-up period and 4 of the BPD subjects still had such symptoms at the age of 1 year. Hoarseness was more frequent in BPD cases than in the controls (8/1 cases). One subject with BPD had transient symptoms of cor pulmonale and 1 without BPD developed transient systemic hypertension. Nine subjects (4 with BPD and 2 controls) had a diagnosis of cerebral palsy at the age of 1 year.     

Carotid stenosis by digital subtraction angiography: reproducibility of the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial measurement methods and visual interpretation.

PURPOSETo evaluate different carotid stenosis estimation methods with digital subtraction angiography.METHODSWe assessed the intraobserver reproducibilty and interobserver variability of visual interpretation and the measurement methods used by the European Carotid Surgery Trial and the North American Symptomatic Carotid Endarterectomy Trial. Angiographic stenosis measurements according to both criteria were performed twice by a radiologist, a neurologist, and a vascular surgeon. Eighty bifurcations of consecutive symptomatic patients underwent 480 pairs of measurements. In addition, four radiologists estimated the stenoses visually.RESULTSIntraobserver consistency was slightly better by the European (kappa, 0.86 to 0.94) than by the North American (kappa, 0.68 to 0.91) trial criteria or by visual interpretation (kappa, 0.79 to 0.81). No significant interobserver variability was found, except in the subgroup of mild stenoses by the North American Trial criteria. By kappa statistic, the interobserver agreement was excellent by the European trial method (kappa, 0.72 to 0.86), good by the North American trial method (kappa, 0.59 to 0.77), and good to excellent by visual evaluation (kappa, 0.68 to 0.88). The visual estimation agreed more closely with the European (kappa, 0.73 to 0.92) than with the North American trial (kappa, 0.55 to 0.74) criteria measurements.CONCLUSIONSAll three methods have good reproducibility in digital subtraction angiography. Interobserver differences become more important in the estimation of mild stenosis.