Relationship between mandibular symphysis dimensions and skeletal pattern in adults

Background: The knowledge of dimensions of the symphysis is important for morphological and orthodontic studies. This research evaluates the association between mandibular symphysis dimensions and anteroposterior and vertical skeletal patterns in adults. Materials and methods: This cross-sectional cephalometric study included 90 lateral cephalograms of untreated subjects presenting for orthodontic treatment. The inclusion criteria were adults with lateral cephalograms showing the symphyseal region and anterior cranial base. One investigator traced and analyzed all cephalograms. Symphyseal height, thickness, and ratio between height and thickness were measured in relation to seven anteroposterior and vertical skeletal measurements in females and males. Results: Symphyseal measurements were associated with SNAo (anteroposterior) in females and Gonial angle (vertical) in males. When analyzed by anteroposterior skeletal classification (ANBo), no significant differences in symphyseal dimensions were found. Multiple linear regression analyses showed that Gonion-Nerve (mm) and Gonial angle were significantly associated with symphyseal height. Gonion-Nerve (mm), basal bone width (mm), and alveolar bone height (mm) were associated with symphyseal thickness. Basal bone width (mm) and alveolar bone height (mm) were associated with symphyseal ratio. Conclusions: Symphyseal dimensions were significantly associated with vertical but not anteroposterior skeletal patterns. Future studies are warranted to evaluate the Gonion-nerve measurements concerning the symphysis in relation to vertical and anteroposterior skeletal patterns

IDegLira Improves Both Fasting and Postprandial Glucose Control as Demonstrated Using Continuous Glucose Monitoring and a Standardized Meal Test

Objective: IDegLira is a novel, fixed-ratio combination of the long-acting basal insulin, insulin degludec, and the long-acting glucagon-like peptide-1 analog liraglutide. We studied the effect of IDegLira versus its components on postprandial glucose (PPG) in type 2 diabetes. Methods: In this substudy, 260 (15.6%) of the original 1663 patients with inadequate glycemic control participating in a 26-week, open-label trial (DUAL I) were randomized 2:1:1 to once-daily IDegLira, insulin degludec or liraglutide. Continuous glucose monitoring (CGM) for 72 hours and a meal test were performed. Results: At week 26, IDegLira produced a significantly greater decrease from baseline in mean PPG increment (normalized iAUC0-4h) than insulin degludec (estimated treatment difference [ETD] -'12.79 mg/dl [95% CI: -'21.08; -'4.68], P =.0023) and a similar magnitude of decrease as liraglutide (ETD -'1.62 mg/dl [95% CI: -'10.09; 6.67], P =.70). CGM indicated a greater reduction in change from baseline in PPG increment (iAUC0-4h) for IDegLira versus insulin degludec over all 3 main meals (ETD -'6.13 mg/dl [95% CI: -'10.27, -'1.98], P =.0047) and similar reductions versus liraglutide (ETD -'1.80 mg/dl [95% CI: -'2.52, 5.95], P =.4122). Insulin secretion ratio and static index were greater for IDegLira versus insulin degludec (P =.048 and P =.006, respectively) and similar to liraglutide (P =.45 and P =.895, respectively). Conclusions: Once-daily IDegLira provides significantly better PPG control following a mixed meal test than insulin degludec. The improvement is at least partially explained by higher endogenous insulin secretion and improved beta cell function with IDegLira. The benefits of liraglutide on PPG control are maintained across all main meals in the combination

One-year efficacy and safety of a fixed combination of insulin degludec and liraglutide in patients with type 2 diabetes: results of a 26-week extension to a 26-week main trial

AimsTo confirm, in a 26‐week extension study, the sustained efficacy and safety of a fixed combination of insulin degludec and liraglutide (IDegLira) compared with either insulin degludec or liraglutide alone, in patients with type 2 diabetes.MethodsInsulin‐naïve adults with type 2 diabetes randomized to once‐daily IDegLira, insulin degludec or liraglutide, in addition to metformin ± pioglitazone, continued their allocated treatment in this preplanned 26‐week extension of the DUAL I trial.ResultsA total of 78.8% of patients (1311/1663) continued into the extension phase. The mean glycated haemoglobin (HbA1c) concentration at 52 weeks was reduced from baseline by 1.84% (20.2 mmol/mol) for the IDegLira group, 1.40% (15.3 mmol/mol) for the insulin degludec group and 1.21% (13.2 mmol/mol) for the liraglutide group. Of the patients on IDegLira, 78% achieved an HbA1c of <7% (53 mmol/mol) versus 63% of the patients on insulin degludec and 57% of those on liraglutide. The mean fasting plasma glucose concentration at the end of the trial was similar for IDegLira (5.7 mmol/l) and insulin degludec (6.0 mmol/l), but higher for liraglutide (7.3 mmol/l). At 52 weeks, the daily insulin dose was 37% lower with IDegLira (39 units) than with insulin degludec (62 units). IDegLira was associated with a significantly greater decrease in body weight (estimated treatment difference, −2.80 kg, p < 0.0001) and a 37% lower rate of hypoglycaemia compared with insulin degludec. Overall, all treatments were well tolerated and no new adverse events or tolerability issues were observed for IDegLira.ConclusionsThese 12‐month data, derived from a 26‐week extension of the DUAL I trial, confirm the initial 26‐week main phase results and the sustainability of the benefits of IDegLira compared with its components in glycaemic efficacy, safety and tolerability

Neuroendocrine (Merkel cell) carcinoma of the retroperitoneum with no identifiable primary site

<p>Abstract</p> <p>Background</p> <p>Neuroendocrine carcinoma is an aggressive neoplasm that mainly affects elderly Caucasians and typically arises in sun-exposed areas of the skin. The disease is rather rare and only a relatively few cases present with no apparent primary lesion.</p> <p>Case presentation</p> <p>We report a case of an 81-year-old Caucasian male with neuroendocrine carcinoma, which initially presented as a large retroperitoneal mass. Pathological and immunohistochemical analysis of the transabdominal CT-guided biopsy specimen revealed tissue consistent with neuroendocrine carcinoma. The patient underwent exploratory laparotomy and the mass was successfully excised along with an associated mesenteric lymph node.</p> <p>Discussion</p> <p>There are currently two possible explanations for what occurred in our patient. First, the retroperitoneal mass could be a massively enlarged lymph node where precursor cells became neoplastic. This would be consistent with a presumptive diagnosis of primary nodal disease. Alternatively, an initial skin lesion could have spontaneously regressed and the retroperitoneal mass represents a single site of metastasis. Since Merkel cell precursors have never been identified within lymph nodes, the latter theory seems more befitting. Moreover, metastasis to the retroperitoneal lymph nodes has been reported as relatively common when compared to other sites such as liver, bone, brain and skin.</p> <p>Conclusion</p> <p>Wide local excision of the primary tumor is the surgical treatment of choice for localized disease. We propose that further studies are needed to elucidate the true efficacy of chemotherapy in conventional as well as unconventional patients with neuroendocrine carcinoma.</p

Flexible eating and flexible insulin dosing in patients with diabetes: results of an intensive self-management course

Aims: To evaluate the outcomes of an established programme to teach patients to match their insulin dose to their carbohydrate intake. Research design and methods: A prospective observational study in Australia (Newcastle, NSW) of 137 consecutive patients with type 1 (n = 82) or type 2 diabetes (n = 55) over two successive years. Four educational principles were used to teach intensive insulin management and diabetes self-care skills including: carbohydrate counting and insulin dose adjustment, exercise, appropriate treatment of hypoglycaemia and hyperglycaemia, managing sickness, problem solving, communication with health professionals, goal setting, and the importance of support. Outcomes included changes at 4 and 12 months in HbA1c, self-efficacy measured by a diabetes empowerment scale (DES), diabetes specific quality of life (ADDQoL), and problem solving. Both intention to treat and efficacy analyses were performed. Results: Diabetes-related quality of life and diabetes problem solving skills improved significantly. Excluding 16 people who failed to adopt intensive insulin management and 24 who started with an HbA1c less than 7%, intention to treat analysis showed the average HbA1c fell from 8.7% initially to 8.1% at 12 months and the number of people with an HbA1c of less than 8% rose from 67 (48.9%) before the program to 86 (62.8%) afterwards. Conclusions: An intensive diabetes self-management program led to improvements in HbA1c, empowerment, and quality of life that were largely sustained at 1 year. This is all the more remarkable given that the intervention was once only, entailed no long-term follow-up, and took place in normal clinical operations

A review of immune cells and molecules in women with recurrent miscarriage

Immunological rejection of the fetus due to recognition of paternal antigens by the maternal immune system, resulting in abnormal immune cells and cytokine production, is postulated to be one cause of unexplained pregnancy loss. Although there is evidence for this in rodents, there is less evidence in humans. This article focuses on studies in humans, and reviews the recent literature on the differences in immune cells and molecules in normal fertile women and women with recurrent miscarriage (RM). Although much of the evidence is contradictory, these studies do suggest differences in the expression of some immune cells and molecules in women with RM. Differences in the CD56+ population of cells are seen, and there is some evidence for an alteration in the ratio of Th1 and Th2 cytokines produced by peripheral blood monocytes (PBMCs) and clones of decidual CD4+ cells. There is also some evidence for differences in endometrial cytokine production, and in particular decreased production of pro-inflammatory cytokines such as interleukin-6. Possible reasons for the variations in data are discussed, and the importance of compartment (peripheral blood, endometrium or decidua) in which the cells and molecules are measured and the timing of the sampling, both with respect to the menstrual cycle and pregnancy (at the time or just after miscarriage)is emphasized.</p

One‐year efficacy and safety of a fixed combination of insulin degludec and liraglutide in patients with type 2 diabetes: results of a 26‐week extension to a 26‐week main trial

AIMS: To confirm, in a 26‐week extension study, the sustained efficacy and safety of a fixed combination of insulin degludec and liraglutide (IDegLira) compared with either insulin degludec or liraglutide alone, in patients with type 2 diabetes. METHODS: Insulin‐naïve adults with type 2 diabetes randomized to once‐daily IDegLira, insulin degludec or liraglutide, in addition to metformin ± pioglitazone, continued their allocated treatment in this preplanned 26‐week extension of the DUAL I trial. RESULTS: A total of 78.8% of patients (1311/1663) continued into the extension phase. The mean glycated haemoglobin (HbA1c) concentration at 52 weeks was reduced from baseline by 1.84% (20.2 mmol/mol) for the IDegLira group, 1.40% (15.3 mmol/mol) for the insulin degludec group and 1.21% (13.2 mmol/mol) for the liraglutide group. Of the patients on IDegLira, 78% achieved an HbA1c of <7% (53 mmol/mol) versus 63% of the patients on insulin degludec and 57% of those on liraglutide. The mean fasting plasma glucose concentration at the end of the trial was similar for IDegLira (5.7 mmol/l) and insulin degludec (6.0 mmol/l), but higher for liraglutide (7.3 mmol/l). At 52 weeks, the daily insulin dose was 37% lower with IDegLira (39 units) than with insulin degludec (62 units). IDegLira was associated with a significantly greater decrease in body weight (estimated treatment difference, −2.80 kg, p < 0.0001) and a 37% lower rate of hypoglycaemia compared with insulin degludec. Overall, all treatments were well tolerated and no new adverse events or tolerability issues were observed for IDegLira. CONCLUSIONS: These 12‐month data, derived from a 26‐week extension of the DUAL I trial, confirm the initial 26‐week main phase results and the sustainability of the benefits of IDegLira compared with its components in glycaemic efficacy, safety and tolerability