Efficacy of adjunctive local periodontal treatment for type 2 diabetes mellitus patients with periodontitis: A systematic review and network meta-analysis.

OBJECTIVES: To investigate the effectiveness of different adjunctive local treatments combined with non-surgical periodontal therapy (NSPT) to reduce pocket depth (PD), gain clinical attachment level (CAL), and/or reduce glycated hemoglobin (HbA1c) in individuals with both type 2 diabetes mellitus (T2DM) and periodontitis in a systematic review and network meta-analysis. DATA SOURCES: Publications were searched in Cochrane databases, EMBASE, Google Scholar, MEDLINE, PubMed, opengrey.eu, and www. CLINICALTRIALS: gov up to May 29, 2024 with no language restriction. STUDY SELECTION: Only randomized controlled trials (RCTs) were included. Network meta-analysis utilized frequentist models. DATA: The network meta-analysis of 30 RCTs involving 1224 patients revealed that, in short-term (2-3 months) and medium-term (4-6 months), adjunctive local treatment involving statins or metformin significantly outperformed scaling and root planning (SRP) with/without additional interventions such as photodynamic and laser therapies (PDT/LT), phytotherapy, doxycycline, bisphosphonates, antibiotics, antiseptics, or placebo for reducing PD and/or gaining CAL. In the long-term (>6 months), statins yielded the most significant additional PD reduction and CAL gain, followed by antibiotics, compared to SRP with antiseptics or placebo. Only PDT/LT demonstrated significantly greater HbA1c reduction in the short term compared to SRP with/without statins, antiseptics, or placebo. CONCLUSION: This study moderately supports that adding metformin or statins locally to NSPT may enhance PD reduction and CAL gain compared to SRP with/without placebo. CLINICAL SIGNIFICANCE: Clinicians are guided to optimize adjunctive therapies, enhancing the health of patients with type 2 diabetes and periodontitis. A strategic approach is proposed to tackle systemic and oral health challenges simultaneously.

A study on the relationships of place attachment and individual attributes of residents in different vulnerable districts in Taipei, Taiwan.

Under the impact of climate change, Taiwan, an island state, has faced the challenges of extreme weather events in recent years. Based on previous studies on climate change and vulnerability in Taipei, Taiwan, this study explores the correlations between place attachment and individual attributes of residents in different vulnerable areas in Taipei. First, this study investigates the integrated vulnerability (IV) of 12 districts of Taipei by overlaying natural vulnerability (NV) and social vulnerability (SV). This study selects four districts with high IV and low IV in Taipei, and with a large proportion of flooded areas, as the study sites. Second, a questionnaire survey (600 respondents) is conducted to examine the correlations between place attachment and the individual attributes of the respondents (age, residence duration, disaster experience, and education) in the four districts. Third, factor analyses are carried out to categorize place attachment into four factors: "security," "familiarity," "belongingness," and "rootedness." Finally, whether different factors have different relationships with place attachment are elucidated. The results show no consistent correlations between place attachment and individual attributes in areas with different vulnerabilities. Furthermore, by comparing the correlations before and after factor analyses of place attachment, among the four factors of place attachment (security, familiarity, belongingness, rootedness), there are no factors significantly relating to overall place attachment. This study further examines the mediator effect between risk experience and place attachment. The results show no mediator effects in the relationships of "perception → place attachment → coping behavior" and "attitude → place attachment → coping behavior." Follow-up studies can elucidate factor analyses of place attachment and examine the effect of geographical scale (neighborhood, district, and city) on place attachment.

Three-phase treatment concept for skeletal Class III growing patients with severe space deficiency: A report of three cases with skeletally anchored maxillary protraction.

This report provides three-phase concept for treating skeletal Class III growing patients with severe space deficiency. Three cases are presented. All had received miniplate-anchored facemask treatment and followed till near completion of growth. Infrazygomatic miniplates were used for both facemask protraction and distalization of the dentition to relieve crowding. With the aid of bone-anchored facemask, maxillary protraction may be continued independent of the orthodontic tooth movement even in late postpubertal growth peak stage. With cephalometric superimpositions using the structural method, we have demonstrated how vertical dental change could affect the skeletal changes and overall clinical outcomes. The persistent mandibular growth during pubertal growth spurt plays a main role in decreasing the effects of maxillary protraction. To keep up with the mandibular growth, we recommend using skeletally anchored facemask long-term till the end of growth spurt. Applying maxillary protraction from infrazygomatic miniplates exposed at the molar area has the merits that it avoids unwanted palatal rotation and that the miniplates maybe used as orthodontic anchorage when indicated. We emphasize the importance of planning the treatment contemplating the skeletal developmental stage and the completion of dental arches. This prolonged orthopedic treatment may contribute to greater long-term effects and stability.

Vulnerability and ecological footprint: a comparison between urban Taipei and rural Yunlin, Taiwan.

Climate change issues and adaptation strategies have drawn much attention from many fields in recent years. Taiwan, an island state, is deeply threatened by the multiple threats posed by climate change. However, different urban and rural areas have numerous adaptation approaches due to their differences in vulnerability. In Taipei City (urban), its biophysical vulnerability is mainly affected by flooded areas and high flood depths caused by landslides and heavy rains. Its social vulnerability is affected by economic development, high household assets, and population concentration. In Yunlin County (rural), its biophysical vulnerability is also affected by flooded areas and high flood depths caused by heavy rains. Its social vulnerability is affected by the elderly living alone, low household assets, and low healthcare. In order to propose appropriate adaptation strategies of urban and rural areas under different vulnerabilities, this study uses an overlapping method to examine the relationship between the integrated vulnerability (biophysical and social) of Taipei and Yunlin along with the ecological footprint (EF), a measurement of human demands for resources and ecological services. This study reviews the literature and uses Taiwan's NCDR (National Science and Technology Center for Disaster Reduction) data to analyze the biophysical vulnerability and the social vulnerability and further calculate the integrated vulnerability. In this study, questionnaire surveys were conducted. In Taipei, 446 valid questionnaires were collected, while 393 were collected in Yunlin. The results show that personal EF in Taipei is higher than that in Yunlin. In the end, this study elucidates the relationship between integrated vulnerability and personal EF of Taipei and Yunlin. Four types of risk areas in urban Taipei and rural Yunlin are sorted out (high vulnerability/high EF, high vulnerability/low EF, low vulnerability/high EF, and low vulnerability/low EF). The empirical results can be adopted by local governments, communities, and NGOs to establish appropriate strategies for mitigation and adaptation in the different risk areas.

Management of paediatric obstructive sleep apnoea: A systematic review and network meta-analysis.

BACKGROUND: Obstructive sleep apnoea (OSA) affects many children, and adenotonsillar hypertrophy is the most common cause of paediatric OSA. AIM: Despite the growing treatment options, there is no comprehensive comparison of all interventions. We aimed to compare and rank the effectiveness of various treatments in a network meta-analysis. DESIGN: Literature was searched from inception to 13 May 2018 for paediatric OSA with adenotonsillar hypertrophy. The outcomes were the changes in apnoea-hypopnea index (AHI), oxyhaemoglobin desaturation index (ODI), and lowest arterial oxygen saturation (SaO2 ). Frequentist approach to network meta-analysis was used. Treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. RESULTS: Fourteen trials comprising 1064 paediatric OSA participants evaluating ten interventions (adenotonsillectomy, adenotonsillectomy + pharyngoplasty, adenotonsillotomy, antimicrobial therapy, steroids, leukotriene receptor antagonists [LTRAs], steroids + LTRAs, rapid maxillary expansion [RME], placebo, and no treatment) were identified for network meta-analysis. In terms of effectiveness in AHI reduction, surgical approach was still the most effective intervention than no treatment. RME was one of the most effective interventions to improve lowest SaO2 . No comparisons showed statistical significance in reducing ODI. CONCLUSIONS: Irrespective of the intervention used, complete resolution of OSA was not achieved in most trials.

Short-term efficacy of minimally invasive treatments for adult obstructive sleep apnea: A systematic review and network meta-analysis of randomized controlled trials.

Many treatments have been proposed for adult obstructive sleep apnea (OSA), but no comprehensive comparison of all interventions has been performed. We aimed to compare and rank the effectiveness of all minimally invasive treatments for adult OSA in a systematic review and network meta-analysis. Literature was searched within Ovid MedLine, EMBASE Classic+Embase, Cochrane library, and Cochrane Database of Systematic Reviews from inception to Aug 9th, 2016 for randomized controlled trials comparing minimally invasive treatments for adult OSA. The outcomes were the changes in apnea-hypopnea index (AHI) and Epworth sleepiness scale (ESS). Frequentist approach to network meta-analysis was used and treatment hierarchy was summarized according to the surfaces under the cumulative ranking curves. Eighty-nine randomized controlled trials comprising 6346 adult OSA participants and comparing 18 different interventions were included. In comparison with no treatment, positive airway pressure (PAP) was most effective in reducing AHI (23.28 [weighted mean difference]; 95% confidence interval: 19.20-27.35). PAP was ranked first followed by mandibular advancement device (MAD) in reducing AHI. Exercise was ranked first followed by cervico-mandibular support collar in reducing ESS. Considering the effectiveness in reducing both AHI and ESS, PAP was ranked the best, followed by MAD and positional therapy, while lifestyle modification alone was the least effective intervention. Interventions that are highly effective in reducing objective laboratory-derived AHI do not demonstrate equivalent effectiveness in improving patients' subjective sleepiness. Future improvement of the interventions is necessary to simultaneously improve both objective and subjective outcomes.

10-Gbit/s direct modulation of a TO-56-can packed 600-µm long laser diode with 2% front-facet reflectance.

A 600-µm long-cavity laser diode with a front-facet reflectance of 2% is demonstrated as a colorless OC-192 transmitter for the future DWDM-PON, which is packed in a TO-56-can package of only 4-GHz frequency bandwidth but can be over-bandwidth modulated with 10-Gbit/s non-return-to-zero data-stream. The coherent injection-locking successfully suppresses its side-mode intensity and noise floor level, which further improves its modulation throughput at higher frequencies. With increasing the coherent injection-locking power from -12 to -3 dBm, the side-mode suppression ratio significantly increases from 39 to 50 dB, which also suppresses the frequency chirp from -12 to -4 GHz within a temporal range of 150 ps. The dense but weak longitudinal modes (with 0.6-nm spacing) in the long-cavity laser diode suppresses to one single-mode in a 100-GHz wide DWDM channel for carrying the OC-192 data at 9.953 Gbit/s. Such an over-bandwidth modulated laser diode still exhibits an on/off extinction ratio of 6.68 dB and a signal-to-noise ratio of 4.96 dB, which can provide a back-to-back receiving power sensitivity of -12.2 dBm at BER of 10⁻9. After 25-km DSF transmission of the OOK data-stream at a bit rate up to 10 Gbit/s, the receiving power sensitivity is -10.1 dBm at a requested BER of 10⁻9.