Metabolic syndrome – a risk factor for all-cause disability pension: a prospective study based on the Swedish WOLF cohort

ObjectiveThe aim was to study the impact of metabolic syndrome on the risk for disability pension among Swedish employees.MethodsA working population-based prospective cohort [Work, Lipids and Fibrinogen (WOLF) cohort, N=10 803], was linked to national registry records of all-cause disability pension for the period 1992–2013. Occupational health service data included 1992–2009 anthropometric measurements, blood samples, and questionnaires. Metabolic syndrome was defined according to International Diabetes Federation criteria, and risk for any all-cause disability pension was analyzed using Cox proportional hazard regression as hazard ratios (HR) with 95% confidence intervals (CI) adjusted for age, sex and other covariates.ResultsOf the employees, 17.9% (men 21.5%, women 9.7%) met the criteria for metabolic syndrome. The prevalence of all-cause disability pension was 15.2% in men with metabolic syndrome and 7.5% in men without metabolic syndrome; for women, the corresponding results were 23.2% and 12.7%. After adjustment for socio-demographic factors, health behaviors, work-related factors, diabetes, and obesity, the risk for all-cause disability pension among subjects with metabolic syndrome displayed an HR of 1.37 (95% CI 1.18–1.60). Results were similar for men and women. In a subgroup, further adjustment for chronic diseases resulted in an HR of 1.32 (95% CI 1.04–1.68).ConclusionThis study demonstrates an increased risk for all-cause disability pension, even after adjustment for other risk factors, among Swedish employees with metabolic syndrome compared to those without at baseline.     

Posttreatment with the immunosuppressant cyclosporin A in transient focal ischemia

Cyclosporin A (CsA) reduces ischemic brain damage when administered in such a way that its penetration across the blood-brain barrier is enhanced. Since only pretreatment has previously been used in focal ischemia, the objective of the present study was to establish whether posttreatment is efficacious and to assess the window of therapeutic opportunity for CsA. To that end, CsA was given 5 min to 6 h after the start of reperfusion following 2 h transient ischemia, and infarct volume was assessed after 48 h by triphenyltetrazolium chloride staining. Attempts were made to circumvent the BBB to CsA by an intracerebral needle lesion, by an increase in the intravenous CsA dose, or by osmotic opening with intracarotid mannitol. The results were compared to those obtained with FK506. Intravenous CsA in a dose of 10 mg/kg failed to reduce infarct volume, unless preceded by a needle lesion. That procedure, and an increase in CsA dose to 50 mg/kg, reduced infarct volume to about 50% of control, but the higher dose had toxic side effects. The coupled intracarotid infusion of mannitol and CsA (10 mg/kg) was more efficacious, without overt side effects. However, mannitol proved dispensable since CsA alone reduced infarct volume to 30% of control, with a therapeutic window of 3-6 h. When given after 5 min of reflow, CsA reduced infarct volume to 10% of control and was clearly more neuroprotective than FK506. Possibly, this is because CsA blocks the mitochondrial permeability transition pore which is opened under adverse conditions.     

Preventing Wrong Tooth Extraction

Objective of WorkWrong-site tooth extraction (WSTE) is the most common serious patient safety incident in dentistry. Safety checklists have significantly reduced wrong-site surgery, although their benefit is unproven in primary care dentistry. Our quality improvement project developed and implemented a checklist optimised for oral surgery procedures in primary care to reduce WSTE risk.Material and MethodsLocal best practice for tooth extraction record-keeping (LBP), using national guidelines and standards was devised. We then retrospectively audited tooth extraction record-keeping against LBP. Deficiencies in current record-keeping practice were identified and used to design a checklist aimed at improving compliance. We provided a computerised safety checklist compliant with LBP to eleven clinicians at three general dental clinics within our region. The checklist included a pre-operative safety check, a pause to re-confirm the surgical site and a post-operative record-keeping proforma. The checklist was linked to our record-keeping software for use during tooth extraction. We audited checklist completion and compliance with LBP fortnightly for ten weeks.ResultsThe introduction of a safety checklist resulted in increased compliance with LBP for tooth extraction record keeping. At week ten, 67% of records contained the computerised safety checklist. This resulted in a 50% increase in overall compliance with LBP for tooth extraction compared to baseline.ConclusionsA computerised safety checklist for tooth extraction in primary care has potential to improve patient safety by adopting measures to prevent WSTE and standardising communication between clinicians. Checklists in general practice should be encouraged.     

The contribution of employer characteristics to continued employment of employees with residual work capacity: evidence from register data in The Netherlands

Objectives:This study aimed to examine the contribution of employer characteristics to continued employment of employees with residual work capacity. Moreover, we examined whether the contribution of employer characteristics differs across types of employers and employees’ types of diseases.Methods:Register data on disability assessments and employment status of N=84 394 long-term sick-listed employees with residual work capacity were obtained from the Dutch Employee Insurance Agency between 2010 and 2017. The dependent variable was continued employment four months after the assessment. We linked employees to their (former) employer to measure sector, firm size, and workforce composition. The average employment outcome of all employees assessed in the same firm and year served as a proxy measure for the extent of implemented disability-related policies and practices. Using multilevel multiple regression analysis, we compared the relative contribution of employer characteristics with employees’ characteristics.Results:Employer characteristics accounted for 10% of the variability in employment outcomes. In comparison, employees’ socio-demographic and disease characteristics accounted for 13% of the variability. The prevalence of continued employment was lowest in smaller firms and construction and low-wage service-orientated sectors. Furthermore, there were sizeable differences in employment outcomes between similar employers in terms of size, sector and workforce-composition, particularly between larger firms and among employees with mental or musculoskeletal disorders compared to other diseases.Conclusions:This study shows substantial differences between employers in facilitating continued employment of employees with residual work capacity. Encouraging firms to invest more in disability-related policies and practices may result in better employment opportunities for these employees.     

Association of managerial position with cardiovascular risk factors: A fixed-effects analysis for Japanese employees

Objectives:Although higher occupational classes have been reported to be associated with better health, researchers do not fully understand whether such associations derive from the position or individual characteristics of the person in that position. We examined the association between being a manager and cardiovascular disease (CVD) risk factors using unique panel data in Japan that annually observed employees’ occupational class and health conditions.Methods:We analyzed data for 45 888 observations from a Japanese company from 2013 through 2017. The association between being a manager and CVD risk factors (metabolic risks and health-related behaviors) were evaluated using simple pooled cross-sectional analyses with adjustment for age, sex, marital status, and overtime-working hours. We further incorporated employee-level fixed-effects into the models to examine whether the associations were subject to individual time-invariant factors.Results:The pooled cross-sectional analyses showed that, compared to non-managers, managers had 2.0 mg/dl lower low density lipoprotein cholesterol (LDL-C) level, 1.4 mmHg-lower systolic blood pressure, and 0.2 kg/m² lower body mass index (BMI). After adjusting for employee-level fixed-effects, being a manager was associated with a significantly 2.2 mg/dl higher LDL-C level. However, the associations between an individual’s management status and blood pressure or BMI were not significant. Furthermore, managers were 5.5% less likely to exercise regularly and 6.1% less likely to report sufficient sleep in the fixed-effects models, although the pooled cross-sectional analyses did not demonstrate these significant associations.Conclusions:Our findings suggest the necessity of considering these unfavorable health risks associated with being promoted to a manager.     

Volumetric Changes of a Customized Allogeneic Bone Block Measured by Two Image Matching Tools: Introduction of a Novel Assessment Technique for Graft Resorption

ObjectiveThe purpose of this case report was to present a method for the assessment of volumetric changes of bone blocks during healing and demonstrate its practicability by analysing the resorption of a pre-shaped allogeneic bone block used for the reconstruction of a complex maxillary defect.Materials and methodsCBCT-scans of a 19-year-old male treated with an allogeneic bone block were recorded pre-OP, post-OP, and following six months of healing. Graft shrinkage was assessed via two image matching tools, namely coDiagnostiX® and Slicer. A biopsy specimen was harvested along the implant canal at the time of implantation.ResultsThe osseous defect was successfully restored and advanced graft remodelling was found upon re-entry as confirmed by the histomorphometric and histologic analysis. The initial volumes of the graft determined via coDiagnostiX® and Slicer were 0.373 mL and 0.370 mL., respectively, while graft resorption after six months of healing was 0.011 mL (3.00%) and 0.016 mL (4.33%).ConclusionsThe avoidance of bone harvesting and reduction of invasiveness display an important issue in dentoalveolar restorations. However, before grafting materials can be considered a safe alternative, understanding their clinical performance, especially resorption stability, is pivotal. The present case report demonstrates a limited resorption of the allogeneic bone block and further emphasizes the practicability of determining bone resorption by the here introduced method. As our investigation comprises solely one subject, the results should be considered with care and substantiated by further studies.Key words: Allogeneic Bone Graft, Allograft, Bone Block, Graft Resorption, Biomaterials, Bone Grafting, Freeze-dried Bone Allograft (FDBA)     

WHO西太区与“世界中医药学会联合会”中医名词术语国际标准比较研究：精、神、气、血、津、液部分

精、神、气、血、津、液是中医理论中6个非常重要的概念，有关术语在《WHO西太区传统医学国际标准名词术语》中一共收录了59条，“世界中医药学会联合会”（以下简称世中联）《中医基本名词术语中英对照国际标准》中收录了58条。血、津、液的内涵较为具体，有一定的物质基础，理解并不困难。翻译上虽有差异，但亦不难统一。精、神、     

不同中医临床证型下行型鼻咽癌组织细胞核蛋白质差异表达的初步研究

目的： 研究下行型鼻咽癌不同中医临床证型患者原发病灶组织细胞核差异表达蛋白质,为中医证型分类的科学性提供依据。方法：采用双向凝胶电泳及基质辅助激光解吸电离-飞行时间质谱法 (MALDI-TOF-MS)对下行型鼻咽癌火毒困结型、气阴两虚型和气血凝结型患者的鼻咽癌组织细胞核蛋白进行分离和表达谱研究,利用生物信息学方法鉴定差异蛋白质。结果：与下行型鼻咽癌气阴两虚型细胞核蛋白点相比,气血凝结型有28个蛋白点表达上调、12个蛋白点表达下调,火毒困结型有9个点表达上调,19个蛋白点表达下调;与下行型鼻咽癌气血凝结型细胞核蛋白点相比,火毒困结型有25个蛋白点表达上调、18个蛋白点表达下调。MALDI-TOF-MS成功鉴定出3个差异蛋白质,来源于气血凝结型鼻咽癌患者的瘤组织细胞不均一性核糖核蛋白H (heterogeneous nuclear ribonucleoprotein H,hnRNP H)和微管蛋白β链1 (tubulin beta-1 chain,TUB1)表达上调,来源于火毒困结型鼻咽癌患者瘤细胞的核蛋白Ⅵ型胶原蛋白α2链 (type Ⅵ collagen alpha 2 chain,COLⅥA2)前体表达下调。结论：下行型气血凝结型鼻咽癌患者的瘤细胞核蛋白hnRNP H和TUB1表达上调,下行型火毒困结型鼻咽癌患者的瘤细胞核蛋白中COLⅥA2前体表达下调。     

On English translation of infant Tuina points in traditional Chinese medicine

1 Introduction In recent years,several international standardized traditional Chinese medicine (TCM) nomenclatures have been published,including the major ones A Proposed Standard International Acupuncture Nomenclature by World Health Organization (WHO) in 1991[1],International Standard Terminologies on Traditional Medicine in the Western Pacific Region[2] by WHO in the Western Pacific Region (WPRO) in 2007 and International Standard Chinese-English Basic Nomenclature of Chinese Medicine[3] by the World Federation of Chinese Medicine Societies (WFCMS) in 2007.However,an English translation of points applied in infant Tuina therapy is neither contained in any of these standardized nomenclatures,nor in major Chinese-English dictionaries of Chinese medicine[4-6].Infant Tuina is an effective and common therapy used in the pediatric department of Chinese medicine.As the points used in infant Tuina therapy are different from the points used in standard acupuncture,and are essential to practice,the authors believe it is important to make an English translation of infant Tuina points and explore the principles and protocol of their translation.