Group Of Untreated Subjects Research Articles

Treatment of Varicose Veins Affects the Incidences of Venous Thromboembolism and Peripheral Artery Disease

Background Varicose veins are a common problem worldwide. Although it was reported that varicose veins have cosmetic and symptomatic effects and can also lead to an increased risk of incident deep venous thrombosis, pulmonary embolism, and peripheral artery disease, whether varicose vein treatment prevents those serious complications is unknown. Methods This retrospective cohort study used claims data extracted from the Chang Gung Research Database and National Health Insurance Research Database in Taiwan. The study subjects were patients aged ≥20 years who underwent endovenous thermal ablation (ETA) from 2005 to 2016 and a group of untreated subjects who were matched by sex and year of birth. All patients were followed from the index date to the earliest occurrence of peripheral artery disease, deep venous thrombosis, or pulmonary embolism or death or the end of the study. To avoid possible selection bias, 1:4 propensity score matching was implemented and a Cox proportional-hazards model was applied while controlling for potential confounders. We also collected data on complications within 28 days of ETA. Results In total, data on 1323 ETA-treated patients with varicose veins were extracted from the Chang Gung Research Database, while data on 149 586 untreated patients with varicose veins were extracted from the National Health Insurance Research Database. Compared with the untreated group, ETA-treated patients had decreased risks of deep venous thrombosis and peripheral artery disease (adjusted hazard ratio, 0.49 [95% CI, 0.32-0.75] and 0.64 [95% CI, 0.49-0.85]). The incidence rates of deep venous thrombosis and pulmonary embolism after ETA (≤28 days) were 0.296% and 0.074%, respectively. Conclusions ETA treatment of varicose veins was associated with a substantial decrease in the subsequent incidence of thromboembolism and peripheral artery disease compared with that in the absence of treatment. In addition, the incidence rate of postprocedural thromboembolic complications after ETA was low in the Asian population. We suggest that improved disease awareness and appropriate early treatment may help reduce the risk of serious complications.

Treatment of Varicose Veins Affects the Incidences of Venous Thromboembolism and Peripheral Artery Disease.

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Editor's Summary and Q&A: Class III camouflage treatment: What are the limits?

Introduction The purpose of this study was to determine the skeletal, dental, and soft-tissue changes in response to camouflage Class III treatment. Methods Thirty patients (average age, 12.4 ± 1.0 years) with skeletal Class III malocclusions who completed comprehensive nonextraction orthodontic treatment were studied. Skeletal, dental, and soft-tissue changes were determined by using published cephalometric analyses. The quality of orthodontic treatment was standardized by registering the peer assessment rating index on the pretreatment and posttreatment study models. The change in the level of gingival attachment with treatment was determined on the study casts. The results were compared with a group of untreated subjects. Data were analyzed with repeated measures analysis and paired t tests. Results The average change in the Wits appraisal was greater in the treated group (1.2 ± 0.1 mm) than in the control group (–0.5 ± 0.3 mm). The average peer assessment rating index score improved from 33.5 to 4.1. No significant differences were found for the level of gingival attachments between the treatment and control groups. The sagittal jaw relationship (ANB angle) did not improve with camouflage treatment. A wide range of tooth movements compensated for the skeletal changes in both groups. The upper and lower limits for incisal movement to compensate for Class III skeletal changes were 120° to the sella-nasion line and 80° to the mandibular plane, respectively. Greater increases in the angle of convexity were found in the treated group, indicating improved facial profiles. Greater increases in length of the upper lip were found in the treated group, corresponding to the changes in the hard tissues with treatment. Conclusions Significant dental and soft-tissue changes can be expected in young Class III patients treated with camouflage orthodontic tooth movement. A wide range of skeletal dysplasias can be camouflaged with tooth movement without deleterious effects to the periodontium. However, proper diagnosis and realistic treatment objectives are necessary to prevent undesirable sequelae.

Class III camouflage treatment: What are the limits?

The purpose of this study was to determine the skeletal, dental, and soft-tissue changes in response to camouflage Class III treatment. Thirty patients (average age, 12.4 + or - 1.0 years) with skeletal Class III malocclusions who completed comprehensive nonextraction orthodontic treatment were studied. Skeletal, dental, and soft-tissue changes were determined by using published cephalometric analyses. The quality of orthodontic treatment was standardized by registering the peer assessment rating index on the pretreatment and posttreatment study models. The change in the level of gingival attachment with treatment was determined on the study casts. The results were compared with a group of untreated subjects. Data were analyzed with repeated measures analysis and paired t tests. The average change in the Wits appraisal was greater in the treated group (1.2 + or - 0.1 mm) than in the control group (-0.5 + or - 0.3 mm). The average peer assessment rating index score improved from 33.5 to 4.1. No significant differences were found for the level of gingival attachments between the treatment and control groups. The sagittal jaw relationship (ANB angle) did not improve with camouflage treatment. A wide range of tooth movements compensated for the skeletal changes in both groups. The upper and lower limits for incisal movement to compensate for Class III skeletal changes were 120 degrees to the sella-nasion line and 80 degrees to the mandibular plane, respectively. Greater increases in the angle of convexity were found in the treated group, indicating improved facial profiles. Greater increases in length of the upper lip were found in the treated group, corresponding to the changes in the hard tissues with treatment. Significant dental and soft-tissue changes can be expected in young Class III patients treated with camouflage orthodontic tooth movement. A wide range of skeletal dysplasias can be camouflaged with tooth movement without deleterious effects to the periodontium. However, proper diagnosis and realistic treatment objectives are necessary to prevent undesirable sequelae.

Tomato Extract for Hypertension?

In this issue of Cardiovascular Drugs and Therapy, professor Paran and her colleagues report on the beneficial effect of tomato extract on blood pressure in patients who were insufficiently controlled with antihypertensive drugs [1]. In a randomized, placebo-controlled, double-blind cross-over trial they compared the extract to placebo in 50 hypertensive patients who had already been treated with a variety of drugs. While placebo did not have a measurable effect on blood pressure, the extract caused a fall of approximately 13/4 mmHg. The magnitude of this result is comparable to what the same investigators found earlier in a group of untreated subjects with mild hypertension [2]. Taken together, this suggests that the use of antihypertensive agents as in the current study did not modify the hypotensive potential of the extract. This makes the observations even more clinically meaningful and it certainly adds a new tool to the array of life-style interventions which we frequently recommend to our patients. A strong point in the study is that blood pressure was always measured with an automatic device. Nevertheless, it should also be noted that a substantial portion of the study population was over 65 years of age. As ageing is generally thought to be associated with increased oxidative stress, it may be that there is more to be gained with antioxidant therapy in the elderly than in the young. Whether the beneficial effects of tomato extract can be extrapolated to patients with less advanced age, thus remains to be determined. It would also be interesting to know whether a high baseline intake of antioxidant substances from whatever source would enhance or just mitigate the response to the extract. Although Paran and associates have carefully executed their study, there is a point of concern. In fact, the degree of blood pressure changes that they observed is greater than what one would expect. With a baseline blood pressure of, on average, 139/80 mmHg when the two groups were combined one would not anticipate a change in systolic pressure of 10 mmHg or more. Even the most powerful drugs usually do not produce that effect. One wonders, therefore, whether other factors could have contributed to the decline in pressure. Indeed, with other life-style measures such as a high intake of fruit and vegetables gave a fall in blood pressure of ‘only’ 4 mmHg systolic and 1.5 mmHg diastolic was observed [3]. Nevertheless, if at the population level the intake of tomatoes or tomato extract would increase to match that in the Paran study and if the population mean of blood pressure would fall to the same or perhaps a lesser extent, this would have enormous consequences in terms of reduction of cardiovascular risk. Despite the clear-cut effects of the tomato extract, it remains enigmatic why it lowers blood pressure so profoundly. Direct effects on blood pressure of lycopene, beta-carotene, folate, vitamin C and vitamin E have not been described. However, tomatoes are rich in potassium, Cardiovasc Drugs Ther (2009) 23:107–108 DOI 10.1007/s10557-008-6161-4

Role of cranial base flexure in developing sagittal jaw discrepancies

The aim of this longitudinal cephalometric study was to investigate skeletal features in patients with small and large cranial base angles. Two groups of untreated subjects were formed on the basis of a small and large cranial base angle N-S-Ar at the age of 5 years: the large cranial base angle group (n = 22) consisted of subjects with an N-S-Ar angle larger than 125° (mean, 128.1°), and the small cranial base angle group (n = 20) included subjects with an N-S-Ar angle of less than 120° (mean, 117.6°). Cephalometric data of the 2 groups were analyzed at subject ages 5 and 12 years. At both ages, the groups showed significant differences of the variables SNA, SNB, individualized ANB, and Y axis. The unadjusted ANB angle and the angle of convexity N-A-Pg were not significantly different between the 2 groups. According to the individualized norm of the ANB angle, subjects with a large cranial base angle in the primary dentition demonstrated a skeletal Class II tendency both at the initial observation and at the longitudinal follow-up. On the basis of cephalometric variables at 12 years of age, it was possible to classify 88.1% of the initial large and small cranial base angle individuals, indicating a constancy of the skeletal pattern during the longitudinal follow-up. The relationship between cranial base flexure and skeletal pattern of the jaws seems to be established before the age of 5 years. (Am J Orthod Dentofacial Orthop 2002;122:386-91)

Skeletal Class II patterns in the primary dentition

The aim of this longitudinal cephalometric study was to investigate early characteristics of favorable and unfavorable growth. Two groups of untreated subjects with skeletal Class II pattern were formed on the basis of an ANB angle at least 2.5° above the individual norm, according to Järvinen, at age 5. The subjects were followed longitudinally until age 12. The favorable growth group (n = 13) consisted of subjects who exhibited a decrease in the individualized ANB angle of at least 1.5° during follow-up. The unfavorable growth group (n = 10) was characterized by an increase in the individualized ANB angle during the growth period from 5 to 12 years. Early characteristics of unfavorable growth included increased mandibular plane angle (measured to the sella-nasion line and the palatal plane, P <.05), increased lower gonial angle (P <.05), and increased distance from nasion to menton (P <.01), and a decreased ratio of posterior-to-anterior face height (P <.05). At the longitudinal follow-up at age 12, the 2 groups showed significant differences in SNB (P <.01) and individualized ANB (P <.01). The improved sagittal jaw relationship in the favorable growth group was the result of changed mandibular position. Morphogenetic posterior rotation seems to occur early in patients with skeletal Class II pattern and unfavorable growth and might be part of an adaptive mechanism compensating for insufficient mandibular growth.

Unsuspected hyperhomocysteinemia in chronically anticoagulated patients.

Hyperhomocysteinemia is a risk factor for arterial and venous thrombosis. The aim of this study was to evaluate plasmatic homocysteine levels in patients under chronic anticoagulant treatment with dietary restriction of green vegetables. This kind of food is a very important source not only of vitamin K but also of folates, which are involved in Hcy metabolism. It is known that the lower the folate levels, the higher the Hcy concentration, so we suspected that these patients could show hyperhomocysteinemia. A group of patients receiving oral anticoagulant treatment and a restricted diet (Group I, n = 20) was compared with a group of untreated subjects of a similar age that were not on a restricted diet (Group II, n = 35). Group I showed significantly higher levels of plasmatic Hcy and significantly lower levels of serum folate than Group II. Therefore, a diet restricted in vitamin K applied to oral anticoagulated patients could induce an unwanted increase of homocysteine levels.

The effects of three methods of orthodontic appliancetherapy on some commonly used cephalometric angular variables

This investigation was undertaken to study the effects of the Andresen activator functional appliance therapy, Begg therapy, and cervically directed extraoral forces upon several commonly used cephalometric angular variables, with particular reference to the relationship between the maxillary plane (palatal plane) and anterior cranial base as represented by SN line. The material consisted of 107 cases taken from the files of patients who had attended the Orthodontic Department, Eastman Dental Hospital, London. Ninety of the cases had received orthodontic treatment. For each case pretreatment, posttreatment, and postretention radiographs were traced and angular measurements made by means of a Lysta-Dent digitizer linked to an on-line computer. Descriptive statistics and one-sample and two-sample Student's t tests were performed. None of the treatment methods under investigation had a clinically significant effect upon the maxillary plane. An increase in the inclination of the mandibular plane was a feature of Begg and headgear therapies but not of Andresen therapy. Any increase observed was of a temporary nature. While no change in SNA occurred with Andresen therapy, Begg and headgear therapies produced a permanent reduction in the variable. A small reduction was also produced in SNB by Begg and headgear therapies. The behavior of SNB following Andresen therapy was not significantly different from that in the group of untreated subjects. Each appliance method produced a permanent reduction in ANB; however, a similar reduction was also demonstrated in the control group.

Intraclass correlations of periodontal measurements.

Components of variance and intraclass correlation coefficients were computed for changes in attachment level, pocket depth, gingival and plaque index scores for 5 groups of treated periodontal disease patients and 1 group of untreated subjects with periodontal disease. The intraclass correlation coefficients for attachment level change ranged from 0.011 to 0.165 (median 0.067), while intraclass correlation coefficients for pocket depth changes ranged from -0.009 to 0.178 (median 0.071). These intraclass correlation coefficients were much lower than those computed for changes in measurements of plaque which ranged from 0.086 to 0.568 (median 0.268) or gingival inflammation which ranged from 0.119 to 0.522 (median 0.264). Intraclass correlation coefficients at baseline for pocket depths ranged from 0.000 to 0.199 (median 0.053), for plaque accumulation from 0.121 to 0.531 (median 0.222) and for gingival inflammation from 0.229 to 0.596 (median 0.391). The differences in the intraclass correlation coefficients between pocket depth and attachment level on the one hand and plaque accumulation or gingival inflammation on the other could not be explained on the basis of differences in the measurement scale employed, since collapsing measurement scales had little effect on the intraclass correlation coefficients. The observed larger intraclass correlation coefficients for changes in plaque and gingival indices suggest a larger rôle for host contribution to these measurements. In contrast, the data suggest that the major but by no means the sole factor determining the variability of attachment level or pocket depth changes is the nature of the local factors.

Lateral growth of the mandible as revealed by serial intraoral roentgenograms: By A. U. Ricciardi, D.M.D., M.D.S., University of Southern California Dental School, Los Angeles, Calif.

The aim of this longitudinal cephalometric study was to investigate early characteristics of favorable and unfavorable growth. Two groups of untreated subjects with skeletal Class II pattern were formed on the basis of an ANB angle at least 2.5° above the individual norm, according to Järvinen, at age 5. The subjects were followed longitudinally until age 12. The favorable growth group (n = 13) consisted of subjects who exhibited a decrease in the individualized ANB angle of at least 1.5° during follow-up. The unfavorable growth group (n = 10) was characterized by an increase in the individualized ANB angle during the growth period from 5 to 12 years. Early characteristics of unfavorable growth included increased mandibular plane angle (measured to the sella-nasion line and the palatal plane, P <.05), increased lower gonial angle (P <.05), and increased distance from nasion to menton (P <.01), and a decreased ratio of posterior-to-anterior face height (P <.05). At the longitudinal follow-up at age 12, the 2 groups showed significant differences in SNB (P <.01) and individualized ANB (P <.01). The improved sagittal jaw relationship in the favorable growth group was the result of changed mandibular position. Morphogenetic posterior rotation seems to occur early in patients with skeletal Class II pattern and unfavorable growth and might be part of an adaptive mechanism compensating for insufficient mandibular growth.