Comparison of provision of maxillofacial emergency service during the two COVID-19 national lockdowns in the United Kingdom

We previously published a study on the provision of emergency maxillofacial services during the first UK COVID-19 pandemic national lockdown. We repeated the study during the second lockdown and now present our findings that highlight the main differences and learning issues as the services have evolved.

Lipoma of the temporal region: a rare case series

Lipomas are common benign tumours that can occur in most parts of the body. Lipomas arising from the deep temporal fat pad, found between the two layers of the deep temporal fascia, are rare, however; there has been only one documented case report to our knowledge. We describe a second case arising from the temporal fat pad in a patient treated at our unit, having previously reported the first one, and discuss the relevant anatomy and management.

Provision of Emergency Maxillofacial Service During the COVID-19 Pandemic : A Collaborative Five Centre UK Study

The global pandemic of Coronavirus disease (COVID-19) represents one of the greatest challenges to healthcare systems, and has forced medical specialties to rapidly adapt their approaches to patient care. Oral and Maxillofacial Surgery is considered particularly at risk of disease transmission due to aerosol generation during surgical interventions, patient proximity and operating environment. On day 2 (26th March, 2020) of when severe restrictions in population movement were instigated in the United Kingdom, we began a study to prospectively monitor the presentation and management of maxillofacial emergencies at five hospital trusts. Data was collected onto an online live database fed through a smartphone application. Of the total 529 patients over six weeks, 395 attended for face-to-face consultations and 134 patients received remote consultations via telephone or video link. There were 255 trauma related cases, 221 infection and 48 cases of postoperative complications. Most trauma cases were minor soft tissue injury related to slip, trip or fall at home. There were 44 cases of facial fractures with a tendency for conservative treatment. 19 cases were related to domestic violence or self-harm. Of the 216 dental related emergencies, 68% could have been managed in the primary care setting. A quarter of all emergency patients were satisfactorily managed by remote consultations. There was a significant change in the provision of emergency maxillofacial service during the pandemic lockdown. We discuss the study findings as well as the potential implications in relation to planning for possible further COVID- 19 spikes and future pandemics.

Modal decomposition of Laguerre Gaussian beams with different radial orders using optical correlation technique

In this paper, we explore the use of an optical correlation technique to decompose different radial as well as azimuthal order modes of Laguerre Gaussian (LG) beams. We experimentally demonstrate the decomposition of single as well as composite LG beams and compare it with simulations. We report the modal decomposition with 27 dB extinction over several radial and azimuthal orders. Finally, we show that our modal decomposition is capable of sorting mode spectrum consisting of up to 10 LG modes with an accuracy of better than 97.8%.

Investigation of propagation dynamics of truncated vector vortex beams

In this Letter, we experimentally investigate the propagation dynamics of truncated vector vortex beams generated using a Sagnac interferometer. Upon focusing, the truncated vector vortex beam is found to regain its original intensity structure within the Rayleigh range. In order to explain such behavior, the propagation dynamics of a truncated vector vortex beam is simulated by decomposing it into the sum of integral charge beams with associated complex weights. We also show that the polarization of the truncated composite vector vortex beam is preserved all along the propagation axis. The experimental observations are consistent with theoretical predictions based on previous literature and are in good agreement with our simulation results. The results hold importance as vector vortex modes are eigenmodes of the optical fiber.

Epidemiology of basal cell carcinoma: a 10-year comparative study

Basal cell carcinoma (BCC) is a slow-growing and locally aggressive skin cancer. Despite its high incidence, good quality epidemiological data are sparse. We therefore organised a retrospective study of two separate years' incidence of BCC in one county within the United Kingdom (Dorset) with an interval of 10 years between them. There were 2455 patients in 2006, and 3797 in 2016, who had a new diagnosis with corresponding crude incidences of 459.99 and 491.92/100,000 person-years. The male:female ratio was 1:071 for both years. The head and neck was the most common site, with the cheek, nose, and forehead being the most common subsites. This is a substantial increase in the incidence of BCC, and is much higher than previous reported rates for the UK. More stringent local and national registries are required to monitor the increasing numbers of BCC and help health care systems to plan preventive strategies and provide the most effective treatment.

Orbital angular momentum beam excitation using an all-fiber weakly fused mode selective coupler

Orbital angular momentum beam excitation through direct phase-matched coupling is experimentally demonstrated using an all-fiber weakly fused mode selective coupler consisting of a single-mode fiber and a ring-core fiber. Experimental results showing the excited OAM mode purity of up to 75% measured through the standard ring technique not only demonstrate the proof of concept but also provide a baseline for further improvement.

Anesthetic considerations in a parturient with renal tubular acidosis and hypothyroidism undergoing cesarean delivery

Renal tubular acidosis, associated with hypothyroidism, is rare. We present the case of a woman with known renal tubular acidosis and treated hypothyroidism who underwent emergency cesarean delivery under uneventful combined spinal-epidural anesthesia. The rationale for choosing the anesthetic technique and the potential risks associated with anesthesia and renal tubular acidosis are discussed.

An unusual complication of nasolabial flap reconstruction

Squamous cell carcinoma is the most common carcinoma in the oral cavity. Resection of these cancers often requires reconstruction. Nasolabial flaps are a robust and reliable local flap that provide a satisfactory outcome. We report two cases where an epidermoid cyst developed within the scar of the nasolabial flap and review the literature.

Loss of orofacial tissue secondary to septic shock caused by Streptococcus pneumoniae

Purpura fulminans is a rare complication of septic shock with a high mortality. It can result in a severe loss of skin, and often amputation of limbs. Managing the loss of tissue is a challenge that requires a multidisciplinary approach.

Addison's disease as a presentation of metastatic malignant melanoma

Melanoma accounts for 5% of all skin cancers. The risk of metastasis is related to the thickness of the tumour, and can affect local, regional and distant sites. Adrenal metastasis from melanoma of the head and neck is uncommon and often asymptomatic. Addison's disease as a presentation of metastatic melanoma is extremely rare and we are unaware of previous reports in the world literature. We report a case of a patient with metastatic melanoma presenting with signs and symptoms of Addison's disease.

The diagnostic dilemma of a parasympathetic schwannoma in the submandibular gland

Schwannomas are benign soft tissue tumours that arise from nerve sheath cells. They are rare in the salivary glands and are thought to arise from the parasympathetic nerves. We report the case of a 69-year-old man who presented with a painless right submandibular mass that appeared to resemble a pleomorphic adenoma on ultrasonography and, on this basis, proceeded to surgical excision of the gland. We review the relevant literature and highlight the diagnostic pitfalls.

The efficacy of different pre- and post-operative analgesics in the management of pain after orthodontic separator placement: A randomized clinical trial

Introduction:

Pain-free treatment to the patients is considered as an important treatment objective for orthodontic health care providers. However, many orthodontists underestimate the degree of pain experienced by the patients. Hence, this study was conducted as a randomized, double-blinded clinical trial with the following objectives.

Objective:

To study the pain characteristics after separator placement; to compare the efficacy of various commonly used analgesics in pain management and to determine the efficacy of pre- and post-operative analgesics in pain management.

Subjects and Methods:

Data were collected from 154 patients (77 males and 77 females, age group of 14-21 years, with mean age of 18.8 years) who reported to Department of Orthodontics. Patients were randomly divided in to four groups. Group 1: Paracetamol 650 mg, Group 2: Ibuprofen 400 mg, Group 3: Aspirin 300 mg, Group 4: Placebo and the study were conducted as a randomized, double-blinded clinical trial. The patients were instructed to take two tablets, one tablet 1 h before separator placement, and the other one after 6 h. The pain evaluations were made by the patients, when teeth not touching (TNT), biting back teeth together, chewing food (CF) using a 100-mm visual analogue scale for 7 days after separator placement. Patients were advised to record the severity of pain.

Results:

Group 3 (Aspirin 300 mg) showed lowest pain values, followed by Group 2 (ibuprofen 400 mg), and Group 1 (paracetamol 650 mg). All NSAID's achieved good pain control compared to Group 4 (placebo), where the intensity pain was maximum.

Conclusion:

Pre- and post-operative analgesics were found to be more effective in controlling orthodontic pain, after separator placement at all-time intervals.

Equation of state measurements of warm dense carbon using laser-driven shock and release technique

We present a new approach to equation of state experiments that utilizes a laser-driven shock and release technique combined with spatially resolved x-ray Thomson scattering, radiography, velocity interferometry, and optical pyrometry to obtain independent measurements of pressure, density, and temperature for carbon at warm dense matter conditions. The uniqueness of this approach relies on using a laser to create very high initial pressures to enable a very deep release when the shock moves into a low-density pressure standard. This results in material at near normal solid density and temperatures around 10 eV. The spatially resolved Thomson scattering measurements facilitate a temperature determination of the released material by isolating the scattering signal from a specific region in the target. Our results are consistent with quantum molecular dynamics calculations for carbon at these conditions and are compared to several equation of state models.

Progression rates from HbA1c 6.0-6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis

AIMS/HYPOTHESIS

Precise estimates of progression rates from 'prediabetes' to type 2 diabetes are needed to optimise prevention strategies for high-risk individuals. There is acceptance of prediabetes defined by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), but there is some controversy surrounding HbA1c-defined prediabetes ranges, with some favouring 6.0-6.4% (42-46 mmol/mol). Comparing progression rates between groups might aid this issue, thus we aimed to accurately estimate progression rates to diabetes from different prediabetes categories.

METHODS

Meta-analysis of prospective observational studies in which participants had prediabetes at baseline (ADA-defined IFG [5.6-6.9 mmol/l], WHO-defined IFG [6.1-6.9 mmol/l], IGT (7.8-11.0 mmol/l) or raised HbA1c [6.0-6.4%/42-46 mmol/mol]) and were followed up for incident diabetes. Incidence rates were combined using Bayesian random effects models.

RESULTS

Overall, 70 studies met the inclusion criteria. In the six studies that used raised HbA1c, the pooled incidence rate (95% credible interval) of diabetes was 35.6 (15.1, 83.0) per 1,000 person-years. This rate was most similar to that for ADA-defined IFG (11 studies; 35.5 [26.6, 48.0]) and was non-significantly lower than WHO-defined IFG (34 studies; 47.4 [37.4, 59.8]), IGT (46 studies, 45.5 [37.8, 54.5]) and IFG plus IGT (15 studies, 70.4 [53.8, 89.7]). Similar results were seen when the data were analysed by the criteria used to diagnose diabetes.

CONCLUSIONS/INTERPRETATION

This study provides evidence that progression rates differ by prediabetes definition, which has implications for the planning and implementation of diabetes prevention programmes. HbA1c 6.0-6.4% might identify people at a lower diabetes risk than other prediabetes definitions, but further research is needed.

Dynamic self-organizing maps with controlled growth for knowledge discovery

The growing self-organizing map (GSOM) has been presented as an extended version of the self-organizing map (SOM), which has significant advantages for knowledge discovery applications. In this paper, the GSOM algorithm is presented in detail and the effect of a spread factor, which can be used to measure and control the spread of the GSOM, is investigated. The spread factor is independent of the dimensionality of the data and as such can be used as a controlling measure for generating maps with different dimensionality, which can then be compared and analyzed with better accuracy. The spread factor is also presented as a method of achieving hierarchical clustering of a data set with the GSOM. Such hierarchical clustering allows the data analyst to identify significant and interesting clusters at a higher level of the hierarchy, and as such continue with finer clustering of only the interesting clusters. Therefore, only a small map is created in the beginning with a low spread factor, which can be generated for even a very large data set. Further analysis is conducted on selected sections of the data and as such of smaller volume. Therefore, this method facilitates the analysis of even very large data sets.

Comparison of shear bond strength of hydrophilic bonding materials: an in vitro study

AIM

The aim of this study was to evaluate and compare the shear bond strength of hydrophilic materials like Transbond MIP with Assure-fluoride releasing light cure sealant paste system (Reliance orthodontic product), Enhance Lc-adhesion booster (Reliance Orthodontics) Prime and Bond NT-one step adhesive with nanotechnology (Dentsply Product India) with Transbond XT as the control group.

MATERIALS AND METHODS

The study was conducted on 180 extracted human premolar teeth which were divided into five main groups. Each group contained 36 teeth, which were further subdivided into three subgroups containing 12 teeth. The teeth were bonded in three different surface environments namely dry, contaminated with artificial saliva and reprimed after contamination with artificial salvia. The brackets were bonded and cured. The shear bond strength was tested using Instron universal testing machine (4501).

RESULTS

The results were subjected to statistical analysis like 3 factorial ANOVA and compared to post-hoc using the Student Newman levels test. The residual resin on the tooth surface after debonding was evaluated with adhesive remnant index.

CLINICAL SIGNIFICANCE

The results revealed that in situations in which moisture contamination is critical there is distinct advantage in using hydrophilic primers.

Validity of self-assessed waist circumference in a multi-ethnic UK population

AIMS

To investigate validity of waist circumference measurements obtained by self-report and self-measurement with non-verbal pictorial instructions among a multi-ethnic population.

METHODS

Five hundred and twenty-six individuals aged 40-75 years (91 South Asian, 430 White European and five other), who attended a screening programme for Type 2 diabetes, estimated their waist circumference and measured their waist with a paper tape measure. Participants were also provided with simple pictorial instructions for measurement of waist circumference in their preferred language and remeasured their waist circumference. We calculated 95% limits of agreement with measures undertaken by a healthcare professional unaware of prior measures.

RESULTS

Mean age was 56.8 years (sd 9.0), mean BMI 30.0 kg/m(2) (sd 5.6) and mean waist circumference 98.4 cm (sd 14.1). Seventy-nine per cent had high waist circumference according to International Diabetes Federation criteria. The mean of participants' self-reported value was 6.8 cm lower than the healthcare professional measure (sd 8.8; 95% limits of agreement -10.4 to 24.0 cm), with significant differences by sex and ethnicity (South Asian men 7.5 cm, South Asian women 0.1 cm, White European men 7.8 cm, White European women 7.0 cm, P < 0.001). Compared with healthcare professional measures, mean self-measured waist circumference was very similar, both with instructions (0.4 cm higher; sd 5.5 cm; -11.1 to 10.4 cm) and without instructions (0.5 cm lower; sd 5.6; -10.4 to 11.4 cm), but with significant differences by sex and ethnicity (P < 0.001).

CONCLUSIONS

There was systematic underestimation of self-reported waist circumference in this multi-ethnic UK population. The magnitude of underestimation might reduce the performance of risk scores; however, this can be corrected through self-measurement with pictorial instructions.

Klinefelter's syndrome (mosaic) with chromosome 9 inv and schizophrenia

Klinefelter's syndrome is a sex chromosome abnormality with low androgen level. The varied manifestations of the mental symptoms in some of them, that are inexplicable based on their genotype alone, has fascinated the researchers. We present here a case of Klinefelter's syndrome having a karyotype of mos 47, XXY, and also inversion in 9(th) chromosome, with schizophrenia. Despite the view that inv 9 is a normal variant, it is still worthwhile to explore whether it has any role in the etiology of schizophrenia especially when it occurs with other genotypic aberrations that are suspected to have relevance to psychiatric disorders including the Klinefelter's syndrome.

Screening for diabetes using an oral glucose tolerance test within a western multi-ethnic population identifies modifiable cardiovascular risk: the ADDITION-Leicester study

AIMS/HYPOTHESIS

The aim of this study was to determine the frequency of undiagnosed glucose abnormalities and the burden of cardiovascular disease (CVD) risk among south Asians and white Europeans attending a systematic screening programme for type 2 diabetes (ADDITION-Leicester) and to estimate the achievable risk reduction in individuals identified with glucose disorders.

METHODS

Random samples of individuals (n = 66,320) from 20 general practices were invited for a 75 g OGTT and CVD risk assessment. Ten-year CVD risk among screen-detected people with diabetes or impaired glucose regulation (IGR) (impaired fasting glycaemia and/or impaired glucose tolerance [IGT]) was computed using the Framingham-based ETHRISK engine and achievable risk reduction was predicted using relative reductions for treatments extracted from published trials.

RESULTS

A total of 6,041 participants (48% male, 22% south Asian) aged 40-75 years inclusive were included. Undiagnosed glucose disorders occurred more frequently in south Asians than white Europeans; age and sex adjusted odds ratios were 1.74 (95% CI 1.42-2.13) and 2.30 (95% CI 1.68-3.16) for IGT and diabetes respectively. Prevalence of any undetected glucose disorder was 17.5% in the whole cohort. Adjusted 10-year risk was similar in screen-detected people with IGR and diabetes (18.3% vs 21.6%), and was higher in south Asians across the glucose spectrum. Absolute CVD risk reductions of up to 13% in those with screen-detected type 2 diabetes and 6% in IGR are achievable using existing cardioprotective therapies.

CONCLUSIONS/INTERPRETATION

Population screening with an OGTT identifies a significant burden of modifiable CVD risk, especially within south Asian groups. Strategies enticing this population to consider screening programmes are urgently needed as significant risk reduction is possible once a glucose abnormality is identified.

TRIAL REGISTRATION

ClinicalTrials.gov NCT00318032.

FUNDING

The project is funded for support and treatment costs by NHS Department of Health Support for Science and project grants.

The association between anxiety and measures of glycaemia in a population-based diabetes screening programme

AIM

To investigate associations between anxiety and measures of glycaemia in a White European and South Asian population attending community-based diabetes screening.

METHODS

In total, 4688 White European and 1353 South Asian participants (aged 40-75 years) without a previous diagnosis of Type 2 diabetes underwent an oral glucose tolerance test and HbA(1c) measurement, detailed history, anthropometric measurements and completed the short-form Spielberger State Trait Anxiety Inventory.

RESULTS

Anxiety was significantly higher in South Asian participants (mean 34.1; sd 0.37) compared with White European participants (mean 29.8; sd 0.13). Significant correlations were not identified between anxiety and fasting (r = -0.01, P = 0.75), 2-h glucose (r = -0.10, P = 0.24) or HbA(1c) (r = 0.01, P = 0.40).

CONCLUSIONS

Anxiety levels at screening were greater among South Asian people. Fasting, 2-h plasma glucose and HbA(1c) are not affected by anxiety during screening tests for diabetes. Current and proposed screening methods for diagnosis of diabetes are not affected by anxiety at screening.

Multi-population model of a microbial electrolysis cell

This work presents a multi-population dynamic model of a microbial electrolysis cell (MEC). The model describes the growth and metabolic activity of fermentative, electricigenic, methanogenic acetoclastic, and methanogenic hydrogenophilic microorganisms and is capable of simulating hydrogen production in a MEC fed with complex organic matter, such as wastewater. The model parameters were estimated with the experimental results obtained in continuous flow MECs fed with acetate or synthetic wastewater. Following successful model validation with an independent data set, the model was used to analyze and discuss the influence of applied voltage and organic load on hydrogen production and COD removal.

The effect of real-time external resistance optimization on microbial fuel cell performance

This work evaluates the impact of the external resistance (electrical load) on the long-term performance of a microbial fuel cell (MFC) and demonstrates the real-time optimization of the external resistance. For this purpose, acetate-fed MFCs were operated at external resistances, which were above, below, or equal to the internal resistance of a corresponding MFC. A perturbation/observation algorithm was used for the real-time optimal selection of the external resistance. MFC operation at the optimal external resistance resulted in increased power output, improved Coulombic efficiency, and low methane production. Furthermore, the efficiency of the perturbation/observation algorithm for maximizing long-term MFC performance was confirmed by operating an MFC fed with synthetic wastewater for over 40 days. In this test an average Coulombic efficiency of 29% was achieved.

Noble Gases in the Murchison Meteorite: Possible Relics of s-Process Nucleosynthesis

The Murchison carbonaceous chondrite contains a new type of xenon component, enriched by up to 50 percent in five of the nine stable xenon isotopes, mass numbers 128 to 132. This component, comprising 5 x 10(-5) of the total xenon in the meteorite, is released at 1200 degrees to 1600 degrees C from a severely etched mineral fraction, and probably resides in some refractory mineral. Krypton shows a similar but smaller enrichment in the isotopes 80 and 82. Neon and helium released in the same interval also are quite anomalous, being highly enriched in the isotopes 22 and 3. These patterns are strongly suggestive of three nuclear processes believed to take place in red giants: the s process (neutron capture on a slow time scale), helium burning, and hydrogen shell burning. If this interpretation is correct, then primitive meteorites contain yet another kind of alien, presolar material: dust grains ejected from red giants.

A two-population bio-electrochemical model of a microbial fuel cell

This work presents a two-population model describing the competition of anodophilic and methanogenic microbial populations for a common substrate in a microbial fuel cell (MFC). Fast numerical solution of the model is provided by using ordinary differential equations to describe biomass growth and retention in the anodic compartment. The model parameters are estimated and validated using experimental results obtained in four continuous-flow air-cathode MFCs operated at various external resistances and organic loads. Model analysis demonstrates the influence of operating conditions on MFC performance and suggests ways to maximize MFC power output. The model is suitable both for process optimization and on-line control applications.

Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity

AIMS/HYPOTHESIS

Non-invasive measures of aortic stiffness reflect vascular senescence and predict outcome in diabetes. Glucose-mediated elastic artery sclerosis may play an integral role in the development of macrovascular complications. We used carotid-femoral pulse wave velocity ((cf)PWV) to quantify independent associations of fasting glucose, post-challenge glucose and derived insulin resistance (HOMA-IR) with aortic stiffness.

METHODS

(cf)PWV was measured using a 4 MHz continuous wave Doppler ultrasound probe within groups with newly identified age- and sex-matched normal glucose metabolism (NGM), impaired glucose regulation (IGR) and diabetes mellitus populations (n = 570, mean age 59.1, 56% male).

RESULTS

After multivariate adjustment, IGR and diabetes were associated with significant aortic stiffening compared with NGM (adjusted (cf)PWV+/-SE: NGM, 9.15 +/- 0.12 m/s; IGR 9.76 +/- 0.11 m/s, p < 0.001; diabetes, 9.89 +/- 0.12 m/s, p < 0.001). IGR stratification indicated that impaired fasting glucose (IFG; 9.71 +/- 0.12 m/s) and post-challenge (impaired glucose tolerance; 9.82 +/- 0.24 m/s) categories had similar (cf)PWV (p = 0.83). Modelled predictors of (cf)PWV were used to assess independent metabolic associations with arterial stiffness. Fasting glucose concentration (beta = 0.10; 95% CI 0.05, 0.18; p = 0.003), 2 h post-challenge glucose (beta = 0.14; 95% CI 0.02, 0.23; p < 0.001) and HOMA-IR (beta = 0.20, 95% CI 0.05, 0.53; p < 0.001) were independently related to (cf)PWV after adjustment for age, sex, mean arterial pressure, heart rate, body mass index, renal function and antihypertensive medication.

CONCLUSIONS/INTERPRETATION

IGR characterised by fasting or post-challenge hyperglycaemia is associated with significant vascular stiffening. Post-challenge glucose and HOMA-IR are the most powerful metabolic predictors of arterial stiffness, implying hyperglycaemic excursion and insulin resistance play important roles in the pathogenesis of arteriosclerosis.

Rationale and design of the ADDITION-Leicester study, a systematic screening programme and randomised controlled trial of multi-factorial cardiovascular risk intervention in people with type 2 diabetes mellitus detected by screening

Background

Earlier diagnosis followed by multi-factorial cardiovascular risk intervention may improve outcomes in Type 2 Diabetes Mellitus (T2DM). Latent phase identification through screening requires structured, appropriately targeted population-based approaches. Providers responsible for implementing screening policy await evidence of clinical and cost effectiveness from randomised intervention trials in screen-detected T2DM cases. UK South Asians are at particularly high risk of abnormal glucose tolerance and T2DM. To be effective national screening programmes must achieve good coverage across the population by identifying barriers to the detection of disease and adapting to the delivery of earlier care. Here we describe the rationale and methods of a systematic community screening programme and randomised controlled trial of cardiovascular risk management within a UK multiethnic setting (ADDITION-Leicester).

Design

A single-blind cluster randomised, parallel group trial among people with screen-detected T2DM comparing a protocol driven intensive multi-factorial treatment with conventional care.

Methods

ADDITION-Leicester consists of community-based screening and intervention phases within 20 general practices coordinated from a single academic research centre. Screening adopts a universal diagnostic approach via repeated 75g-Oral Glucose Tolerance Tests within an eligible non-diabetic population of 66,320 individuals aged 40-75 years (25-75 years South Asian). Volunteers also provide detailed medical and family histories; complete health questionnaires, undergo anthropometric measures, lipid profiling and a proteinuria assessment. Primary outcome is reduction in modelled Coronary Heart Disease (UKPDS CHD) risk at five years. Seven thousand (30% of South Asian ethnic origin) volunteers over three years will be recruited to identify a screen-detected T2DM cohort (n = 285) powered to detected a 6% relative difference (80% power, alpha 0.05) between treatment groups at one year. Randomisation will occur at practice-level with newly diagnosed T2DM cases receiving either conventional (according to current national guidelines) or intensive (algorithmic target-driven multi-factorial cardiovascular risk intervention) treatments.

Discussion

ADDITION-Leicester is the largest multiethnic (targeting >30% South Asian recruitment) community T2DM and vascular risk screening programme in the UK. By assessing feasibility and efficacy of T2DM screening, it will inform national disease prevention policy and contribute significantly to our understanding of the health care needs of UK South Asians.

Trial registration

Clinicaltrial.gov (NCT00318032).

Searching for the right outcome? A systematic review and meta-analysis of controlled trials using carotid intima-media thickness or pulse wave velocity to infer antiatherogenic properties of thiazolidinediones

INTRODUCTION

Recent meta-analyses cast doubt over purported beneficial effects of Peroxisome Proliferator Activated Receptor-Gamma (PPAR-gamma) receptor agonists. Thiazolidinedione (TZD) trials using surrogate outcomes to postulate an antiatherogenic paradigm have been criticised as misinformative. We conducted an independent systematic review and meta-analysis of controlled TZD studies incorporating carotid intima-media thickness (CIMT) or pulse wave velocity (PWV) as primary outcome measures. The aim was to provide an evidence-based overview of TZD intervention studies using markers prospectively linked to vascular outcome in type 2 diabetes.

METHODS

Systematic search of known databases for TZD intervention trials using mean thickness CIMT(n = 9) and ankle-brachial PWV(n = 6) as primary outcome measures was performed. CIMT and PWV pooled weighted mean difference was calculated using a random effects model accounting for heterogeneity and publication bias. An indirect meta-analysis provided a comparison of rosiglitazone and pioglitazone effects.

RESULTS

A composite of combined placebo and comparator controlled trials demonstrated a significant weighted mean difference of-0.06 mm for CIMT (95% CI-0.09 to-0.02, p = 0.001) and-0.72 ms(-1) for PWV (95% CI-1.28 to-0.16, p = 0.011) in favour of thiazolidiendione treatment. No TZD intraclass variation in CIMT (p = 0.96) or PWV (p = 0.33) change was observed.

CONCLUSION

TZDs exhibit significant beneficial effects on aorto-carotid atherosclerosis when assessed using prospectively validated non-invasive techniques. Inferring clinical benefit in the absence of confirmatory outcome trials is questionable and caution should be exercised when interpreting intervention data with surrogate endpoints. TZD-induced congestive cardiac failure or other unknown PPAR-gamma adverse effects are plausible explanations for the conflicting results of intervention trials using markers of atherosclerosis and clinical event outcomes.

Intraosseous 'haemangioma' of the zygoma: more appropriately termed a venous malformation

Vascular anomalies often affect the soft tissues and primary intraosseous lesions are uncommon, with only 33 cases reported in the zygoma. Intraosseous vascular anomalies of the zygoma have traditionally been designated 'haemangiomas' with little attempt to clarify the specific type of the lesion. Recently, specific immunohistochemical markers such as erythrocyte type glucose transporter protein 1 (GLUT-1) have been described to differentiate haemangiomas and vascular malformations. The authors report a case of intraosseous venous malformation of the zygoma and provide supporting evidence to justify the nomenclature. The literature on zygomatic 'haemangiomas' is critically reviewed and the basis for their proper designation as venous malformations highlighted.