Periodontitis and Gestational Diabetes Mellitus: A Systematic Review and Meta-analysis of Observational Studies

Background: Gestational diabetes mellitus (GDM) is glucose intolerance with first onset during pregnancy and is associated with serious maternal and fetal complications. The etiology of GDM is not well understood, but systemic inflammation effects on insulin signaling and glucose metabolism is suspected. Periodontal disease is a chronic inflammatory condition that induces local and host immune responses and has been evaluated for a potential role in development of GDM. Results from studies evaluating the association between periodontitis and GDM are mixed. We performed a systematic review and meta-analysis to summarize available data regarding the association between periodontitis and GDM. Methods: Twelve electronic databases were searched for observational studies of the association between periodontitis and GDM through March 2016. Eligible studies were assessed for quality and heterogeneity. Random effects models were used to estimate summary measures of association. Results: We identified 44 articles from 115 potentially relevant reports of which 10 studies met our eligibility criteria. Clinical diagnostic criteria for periodontitis and GDM varied widely among studies, and moderate heterogeneity was observed. Random effects meta-analysis of all included studies with a total of 5724 participants including 624 cases, showed that periodontitis is associated with an increased risk of GDM by 66 %, (OR = 1.66, 95 % CI: 1.17 to 2.36; p \u3c 0.05), I2 = 50.5 %. Similar results were seen in sub-analysis restricted to data from methodologically high quality case–control studies including 1176 participants including 380 cases, (OR = 1.85, 95 % CI: 1.03 to 3.32); p \u3c 0.05), I2 = 68.4 %. Meta-analysis of studies that adjusted for potential confounders estimated more than 2-fold increased odds of GDM among women with periodontitis (aOR = 2.08, 95 % CI: 1.21 to 3.58, p = 0.009, I2 = 36.9 %). Conclusion: Meta-analysis suggests that periodontitis is associated with a statistically significant increased risk for GDM compared to women without periodontitis. Robust prospective study designs and uniform definition for periodontitis and GDM definitions are urgently needed to substantiate these findings

Motor Evoked Torque Differences Between ACLR Patient and Control

Anterior cruciate ligament reconstructed (ACLR) patients with quadriceps deficits demonstrate greater motor evoked potential (MEP), indicating altered corticospinal excitability. Recent study has suggested that evoked torque responses to transcranial magnetic stimulation (TMS) is an alternative method to determine motor cortical excitability. However, no study has evaluated the evoked torque in ACLR patients compared to healthy controls. PURPOSE: To evaluate percentage changes in evoked torque values in response to TMS between an ACLR patient (ACLR) and a healthy control (CONT). METHODS: One ACLR (female, 21yrs, 180cm, 77.1kg) and one CONT (female, 39yrs, 160cm, 61.2kg) were seated on HUMAC dynamometer to perform an isometric knee extension at 90° of knee flexion on the reconstructed and matched knee at 10% of their maximum voluntary isometric contraction (MVIC), respectively. Motor evoked torques elicited by 30 trials of TMS over the primary motor cortex at 120% and 140% of active motor threshold (AMT) were measured during the submaximal isometric contraction of the quadriceps. Five resting twitch torques (RTT) directly evoked by TMS over the quadriceps muscle were measured while both subjects were completely relaxed. The percentage change of averaged evoked torque relative to RTT was calculated for MET at both AMT120% and AMT140%. RESULTS: The ACLR showed greater increases in MET at both AMT120% (ACLR: 79.37%, CONT: 63.84%) and AMT140% (ACLR: 141.15%, CONT: 104.73%), when compared to the CONT. CONCLUSION: Our preliminary results may imply that TMS induced greater torque production in the ACLR patient compared to the control, possibly indicating altered corticospinal excitability of the quadriceps muscles after ACLR, with greater alteration at AMT140%. Such excessive involuntary quadriceps contraction in the ACLR patient may indicate recruiting more motor neurons than needed, leading to improper regulation of the quadriceps as well as re-tear of the ACLR. Future studies should examine the direct relationships between the corticospinal excitability and knee function outcomes

Forensic Accountants: Financial Investigators

The public fraud scandals with companies like Enron and WorldCom, the Internet and other technological advances, and even the threat of terrorists have created a large demand for the skills and services provided by forensic accountants.  Forensic accountants are in high demand because they play a critical role in an investigation of suspected financial scandals and misappropriation of assets.  It is their job to bring independence and credibility to these investigations

Association between bilirubin and cardiovascular disease risk factors: using Mendelian randomization to assess causal inference

Background: Elevated serum bilirubin has been associated with reduced risk of cardiovascular disease (CVD). However, serum bilirubin is also related with several potential confounders related to CVD, such as obesity. Mendelian randomization has been proposed as a method to address challenges to validity from confounding and reverse causality. It utilizes genotype to estimate causal relationships between a gene product and physiological outcomes. In this report, we demonstrate its use in assessing direct causal relations between serum bilirubin levels and CVD risk factors, including obesity, cholesterol, measures of vascular function and blood pressure. Methods: Study subjects included 868 asymptomatic individuals. Study subjects were genotyped at the UGT1A1*28 locus, which is strongly associated with bilirubin levels. Results: Serum bilirubin levels were inversely associated with levels of several cardiovascular disease risk factors, including body mass index (p = 0.003), LDL (p = 0.0005) and total cholesterol (p = 0.0002). In contrast, UGT1A1*28 genotype, a known cause of elevated bilirubin levels, was not significantly associated with any of these traditional CVD risk factors. We did observe an association between genotype and brachial artery diameter (p = 0.003) and cold pressor reactivity (p = 0.01). Conclusions: Our findings imply that the observed association of serum bilirubin levels with body mass index and cholesterol are likely due to confounding and suggest that previously established CVD benefits of increased bilirubin may in part be mediated by the early regulation of vascular structure and reactivity

Young female cancer survivors’ use of fertility care after completing cancer treatment

To investigate factors associated with female young adult cancer survivors’ (YCS) use of fertility care (FC), including consultation or fertility treatment, after completing their cancer treatment

Marginal structural models for the estimation of the risk of Diabetes Mellitus in the presence of elevated depressive symptoms and antidepressant medication use in the Women\u27s Health Initiative observational and clinical trial cohorts

BACKGROUND: We evaluate the combined effect of the presence of elevated depressive symptoms and antidepressant medication use with respect to risk of type 2 diabetes among approximately 120,000 women enrolled in the Women\u27s Health Initiative (WHI), and compare several different statistical models appropriate for causal inference in non-randomized settings. METHODS: Data were analyzed for 52,326 women in the Women\u27s Health Initiative Clinical Trials (CT) Cohort and 68,169 women in the Observational Study (OS) Cohort after exclusions. We included follow-up to 2005, resulting in a median duration of 7.6 years of follow up after enrollment. Results from three multivariable Cox models were compared to those from marginal structural models that included time varying measures of antidepressant medication use, presence of elevated depressive symptoms and BMI, while adjusting for potential confounders including age, ethnicity, education, minutes of recreational physical activity per week, total energy intake, hormone therapy use, family history of diabetes and smoking status. RESULTS: Our results are consistent with previous studies examining the relationship of antidepressant medication use and risk of type 2 diabetes. All models showed a significant increase in diabetes risk for those taking antidepressants. The Cox Proportional Hazards models using baseline covariates showed the lowest increase in risk , with hazard ratios of 1.19 (95 % CI 1.06 - 1.35) and 1.14 (95 % CI 1.01 - 1.30) in the OS and CT, respectively. Hazard ratios from marginal structural models comparing antidepressant users to non-users were 1.35 (95 % CI 1.21 - 1.51) and 1.27 (95 % CI 1.13 - 1.43) in the WHI OS and CT, respectively - however, differences among estimates from traditional Cox models and marginal structural models were not statistically significant in both cohorts. One explanation suggests that time-dependent confounding was not a substantial factor in these data, however other explanations exist. Unadjusted Cox Proportional Hazards models showed that women with elevated depressive symptoms had a significant increase in diabetes risk that remained after adjustment for confounders. However, this association missed the threshold for statistical significance in propensity score adjusted and marginal structural models. CONCLUSIONS: Results from the multiple approaches provide further evidence of an increase in risk of type 2 diabetes for those on antidepressants

Morphological diversity of the speckled dace (Rhinichthys osculus) in Oregon's desert springs

The Speckled dace (Rhinichthys osculus) is the most widespread minnow in western North America (Gilbert and Williams, 2002). It has diversified widely across its range—both morphologically and genetically—and as such might rightly be called a species complex. Our ongoing work aims to determine where boundaries between potentially undescribed species lie in Oregon and to identify morphological differences that may help diagnose those taxonomic entities. Meristic and linear morphometric data were collected from preserved specimens originating in four major drainage basins in desert Oregon. Morphometric data points to some potential phenotypic differences between fish reared in springs (slow-moving water) and fish reared in streams (fast-moving water). In particular, spring fish from each basin tend to have shallower bodies and shorter heads than the stream fish from the same basin. The morphologic differences described by this study will give insight in to the evolutionary history of this species complex and how geography has influenced the diversification of R. osculus

Lipid Adjustment in the Analysis of Environmental Contaminants and Human Health Risks

The literature on exposure to lipophilic agents such as polychlorinated biphenyls (PCBs) is conflicting, posing challenges for the interpretation of potential human health risks. Laboratory variation in quantifying PCBs may account for some of the conflicting study results. For example, for quantification purposes, blood is often used as a proxy for adipose tissue, which makes it necessary to model serum lipids when assessing health risks of PCBs. Using a simulation study, we evaluated four statistical models (unadjusted, standardized, adjusted, and two-stage) for the analysis of PCB exposure, serum lipids, and health outcome risk (breast cancer). We applied eight candidate true causal scenarios, depicted by directed acyclic graphs, to illustrate the ramifications of misspecification of underlying assumptions when interpreting results. Statistical models that deviated from underlying causal assumptions generated biased results. Lipid standardization, or the division of serum concentrations by serum lipids, was observed to be highly prone to bias. We conclude that investigators must consider biology, biologic medium (e.g., nonfasting blood samples), laboratory measurement, and other underlying modeling assumptions when devising a statistical plan for assessing health outcomes in relation to environmental exposures

Vitamin D Status Is Not Associated with Risk of Early Menopause

Background: Early natural menopause, the cessation of ovarian function before age 45 y, is positively associated with cardiovascular disease and other conditions. Dietary vitamin D intake has been inversely associated with early menopause; however, no previous studies have evaluated risk with regard to plasma 25-hydroxyvitamin D [25(OH)D] concentrations. Objective: We prospectively evaluated associations of total and free 25(OH)D and vitamin D–binding protein (VDBP) concentrations and the risk of early menopause in a case-control study nested within the Nurses’ Health Study II (NHS2). We also considered associations of 25(OH)D and VDBP with anti-Müllerian hormone (AMH) concentrations. Methods: The NHS2 is a prospective study in 116,430 nurses, aged 25–42 y at baseline (1989). Premenopausal plasma blood samples were collected between 1996 and 1999, from which total 25(OH)D and VDBP concentrations were measured and free 25(OH)D concentrations were calculated. Cases experienced menopause between blood collection and age 45 y (n = 328) and were matched 1:1 by age and other factors to controls who experienced menopause after age 48 y (n = 328). Conditional logistic regression models were used to estimate ORs and 95% CIs for early menopause according to each biomarker. Generalized linear models were used to estimate AMH geometric means according to each biomarker. Results: After adjusting for smoking and other factors, total and free 25(OH)D were not associated with early menopause. Quartile 4 compared with quartile 1 ORs were 1.04 (95% CI: 0.60, 1.81) for total 25(OH)D and 0.70 (95% CI: 0.41, 1.20) for free 25(OH)D. 25(OH)D was unrelated to AMH concentrations. VDBP was positively associated with early menopause; the OR comparing the highest with the lowest quartile of VDBP was 1.80 (95% CI: 1.09, 2.98). Conclusions: Our findings suggest that total and free 25(OH)D are not importantly related to the risk of early menopause. VDBP may be associated with increased risk, but replication is warranted