The relationship of periodontal disease to diseases and disorders at distant sites: communication to health care professionals and patients

BACKGROUND: The body of research defining relationships among periodontal disease and certain systemic diseases and disorders has been expanding, and questions have been raised regarding what information should be conveyed to health care professionals and patients. METHODS: Representatives from dentistry, medicine, the academic community and the insurance industry convened a two-day workshop July 23 and 24, 2007. RESULTS: The workshop participants achieved general consensus on a number of issues, including the need for greater cooperation between the health care professions. This cooperation should translate into improved clinical care as physicians refer patients for dental care, and dentists are proactive in regard to the general health of their patients. CONCLUSION: Communication to health care professionals requires a multifaceted approach that includes publication of research findings in medical and dental journals, cooperation among professional organizations and initiatives at the local level such as presentations at medical grand rounds. Dental schools should play a role in their health science centers. Communication with patients may improve through the use of targeted informational brochures in the offices of medical specialists, appropriate media campaigns and efforts led by local dental organizations. PRACTICE IMPLICATIONS: It is too early to provide specific recommendations regarding the treatment of periodontal disease to improve specific health outcomes, but dentists can become advocates for a general health promotion and disease prevention message. The lifestyles approach includes an improved diet, smoking cessation, appropriate hygiene practices and stress reduction. These strategies can improve oral and general health outcomes.     

Effects of aging and D-glucose on locomotor activity, spontaneous alternation, and plasma glucose levels in preweanling Sprague-Dawley rats

Previous research has shown that developmentally related memory impairments in immature rodents are malleable and may be attenuated using a variety of pharmacological and behavioral treatments. This experiment examined the effects of glucose (10, 100, 250 or 500 mg/kg) or saline on blood glucose level, locomotor activity, and spontaneous alternation (SA) in the T-maze. Studies were conducted with 20-, 22-, and 24-day-old preweanling Sprague-Dawley rats. Results indicated a general decline in blood glucose level with age and size of glucose injection. The largest overall decline in blood glucose was found following the 500 mg/kg dose in 24-day-old animals. An increase in T-maze arm entries with age indicated increased exploratory activity. SA generally improved with age, but glucose had no reliable effect on behavior. The ontogenetic state of the nervous system, including changes in cholinergic system activity, glucoregulation, and proliferation of glucose transporters, is discussed.     

Perfect- and typical-use effectiveness of the Dot fertility app over 13 cycles: results from a prospective contraceptive effectiveness trial

Objective: Dynamic Optimal Timing (Dot) is a smartphone application (app) that estimates the menstrual cycle fertile window based on the user’s menstrual period start dates. Dot uses machine learning to adapt to cycles over time and informs users of ‘low’ and ‘high’ fertility days. We investigated Dot’s effectiveness, calculating perfect- and typical-use failure rates.

Methods: This prospective, 13 cycle observational study (ClinicalTrials.gov NCT02833922) followed 718 women who were using Dot to prevent pregnancy. Participants contributed 6616 cycles between February 2017 and October 2018, providing data on menstrual period start dates, daily sexual activity and prospective intent to prevent pregnancy. We determined pregnancy through participant-administered urine pregnancy tests and/or written or verbal confirmation. We calculated perfect- and typical-use failure rates using multi-censoring, single-decrement life-table analysis, and conducted sensitivity, attrition and survival analyses.

Results: The perfect-use failure rate was calculated to be 1.0% (95% confidence interval [CI]: 0.9%, 2.9%) and the typical-use failure rate was 5.0% (95% CI: 3.4%, 6.6%) for women aged 18–39 (n?=?718). Survival analyses identified no significant differences among age or racial/ethnic groups or women in different types of relationships. Attrition analyses revealed no significant sociodemographic differences, except in age, between women completing 13 cycles and those exiting the study earlier.

Conclusion: Dot’s effectiveness is within the range of other user-initiated contraceptive methods.     

Late stent thrombosis (> 1 year) following clopidogrel withdrawal after brachytherapy treatment: Need to assess aspirin resistance?

We report on a patient presenting with late thrombosis of a stent 15 months after being treated with intracoronary brachytherapy. It occurred 17 days after clopidogrel withdrawal while maintaining treatment with aspirin. At the time of stent thrombosis, evaluation of platelet aggregation was performed, revealing a suboptimal response to aspirin. Pathophysiological insights of aspirin resistance and clinical implications are reviewed.     

Impact of stent deployment procedural factors on long-term effectiveness and safety of sirolimus-eluting stents (final results of the multicenter prospective STLLR trial)

Drug-eluting stent failures were associated with various clinical factors. However, the clinical impact of stent deployment technique was unknown. This study was designed to evaluate the frequency and impact of suboptimal percutaneous coronary intervention on long-term outcomes of 1,557 patients treated with sirolimus-eluting stents (SESs) in 41 US hospitals. All steps of the interventional procedure were scrutinized by an independent core laboratory to determine the occurrence of geographic miss (GM). GM included longitudinal (LGM; injured or diseased segment not covered by SES) or axial GM (balloon-artery size ratio <0.9 or >1.3) mismatches. Patients with and without GM were stratified (GM vs no-GM group). Patients, investigators, and the independent clinical event adjudication committee were blind to study group assignments. The primary end point was 1-year target-vessel revascularization (TVR) rate. Incidences and predictors of GM and safety outcomes were secondary end points. GM occurred in 943 patients (66.5%): 47.6% had LGM, 35.2% had axial GM, and 16.5% had both. One-year TVR rates were 5.1% in the GM group versus 2.5% in the no-GM group (p=0.025). TVR was 6.1% in the LGM versus 2.6% in the no-LGM subgroups (p=0.001). The association of GM with 1-year TVR was independent of clinical or anatomic factors (hazard ratio 2.0, 95% confidence interval 1.0 to 4.02, p=0.05). There was a 3-fold increase in myocardial infarction rates associated with GM (2.4% vs 0.8%; p=0.04). In conclusion, GM occurred frequently during SES implantation and was associated with increased risk of TVR and myocardial infarction at 1 year. These results emphasized the need for improvement in contemporary percutaneous coronary intervention practices and technologies.     

Pharmacokinetic and pharmacodynamic profiles of a novel phospholipid-aspirin complex liquid formulation and low dose enteric-coated aspirin: results from a prospective,randomized, crossover study

Journal of Thrombosis and Thrombolysis - Low dose enteric-coated aspirin (EC-ASA) is routinely used for secondary cardiovascular event prevention. However, absorption of EC tablets is poor, which...