Trends in practice of blood glucose control in critically ill patients in the Netherlands.

BACKGROUND: Publication of the Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial in 2009 and several observational studies caused a change in the recommendations for blood glucose control in intensive care patients. We evaluated local trends in blood glucose control in intensive care units in the Netherlands before and after the publication of the NICE-SUGAR trial and the revised Surviving Sepsis Campaign (SSC) guidelines in 2012. METHODS: Survey focusing on the timing of changes in thresholds in local guidelines for blood glucose control and interrupted time-series analysis of patients admitted to seven intensive care units in the Netherlands from September 2008 through July 2014. Statistical process control was used to visualise and analyse trends in metrics for blood glucose control in association with the moment changes became effective. RESULTS: Overall, the mean blood glucose level increased and the median percentage of blood glucose levels within the normoglycaemic range and in the hypoglycaemic range decreased, while the relative proportion of hyperglycaemic measurements increased. Changes in metrics were notable after publication of the NICE-SUGAR trial and the SSC guidelines but more frequent after changes in local guidelines; some changes seemed to appear independent of changes in local guidelines. CONCLUSION: Local guidelines for blood glucose practice have changed in intensive care units in the Netherlands since the publication of the NICE-SUGAR trial and the revised SSC guidelines. Trends in the metrics for blood glucose control suggest new, higher target ranges for blood glucose control.

Validity, reliability, and reproducibility of linear measurements on digital models obtained from intraoral and cone-beam computed tomography scans of alginate impressions.

INTRODUCTION: Digital 3-dimensional models are widely used for orthodontic diagnosis. The aim of this study was to assess the validity, reliability, and reproducibility of digital models obtained from the Lava Chairside Oral scanner (3M ESPE, Seefeld, Germany) and cone-beam computed tomography scans of alginate impressions for tooth-width measurements and the Bolton analysis. METHODS: A digital model, an intraoral scan, and a plaster model were made for each of 22 subjects. Tooth-width measurements on the digital model and the intraoral scan were compared with those on the corresponding plaster models (gold standard). Intraclass correlation coefficients were calculated to determine the interexaminer reliability of the measurements of each method. The anterior and overall Bolton ratios were calculated for each participant and for each method. The paired t test was used to determine the validity. The scanning time for the intraoral scanner was registered and analyzed. RESULTS: Tooth-width measurements of each tooth on the digital models and the intraoral scans did not differ significantly from those on the plaster models (P >0.05). The overall and anterior Bolton ratios from the 2 types of digital models differed significantly from the gold standard (P <0.05). However, the differences never exceeded 1.5 mm; this could be regarded as clinically insignificant. The scanning times of the intraoral scanner decreased significantly with the number of scans performed. CONCLUSIONS: Both intraoral scanning and cone-beam computed tomography scanning of alginate impressions are valid, reliable, and reproducible methods to obtain dental measurements for diagnostic purposes.

[Validity and reliability of digital diagnostic measurements on digital three-dimensional dental models]. / Validiteit en betrouwbaarheid van digitale diagnostische metingen op digitale driedimensionale gebitsmodellen.

Digital three-dimensional dental models are widely used for orthodontic diagnosis. The aim of this clinical study was to assess the validity and reliability of digital diagnostic measurements on digital three-dimensional dental models. Two types of digital three-dimensional dental models and a plaster dental model were made of 10 volunteers. Digital measurements of the tooth width were compared with the physical measurements of the plaster models. None of the digital diagnostic measurements appeared to differ significantly from the physical measurements.

Photocatalytic degradation of cyanobacterial microcystin toxins in water.

The microcystins are hepatotoxins produced by a number of cyanobacterial species (blue green algae) in fresh water systems. The increasing eutrophication of natural waters has led to an increase in the incidence of algal blooms and the consequent increased risk of microcystin contamination of water resources. The removal of microcystins LR, YR and YA from contaminated water was investigated using an experimental laboratory-scale photocatalytic 'falling film' reactor in which an oxygen purge, UV radiation and semiconductor titanium dioxide (TiO2) catalyst were used to oxidatively decompose the microcystin pollutants. Preliminary studies, using algal extracts spiked into distilled water, indicated that the microcystins were rapidly decomposed in this reactor. The decomposition followed first order reaction kinetics with half-lives of less than 5 min with the reactor operating in a closed-loop mode. Reaction rates were strongly dependent on the amount of TiO2 catalyst (O-5 g/l), but only marginally influenced by a change in gas purge from oxygen to compressed air. The use of lake water, rather than distilled water, showed that this process is feasible in natural waters, although increased levels of catalyst (up to 5 g/l) were required to achieve comparable decomposition rates.

Carcinoma of the soft palate and anterior tonsillar pillar.

The results after treatment of a total of 52 patients between 1974 and 1990 for squamous cell carcinoma of the soft palate and anterior tonsillar pillar by surgery, radiotherapy, or a combination of the two are reported in the present study. Of the 45 patients who were treated for cure, 38 were treated by surgery, followed by radiotherapy in 19 patients (50%). Five patients received definitive radiotherapy only, and 2 were treated by other modalities such as intra-arterial methotrexate and carbon dioxide (CO2) laser. Absolute and determinant 5-year survival rates were 62% and 77%, respectively. Sixty-four percent of patients survived 5 years recurrence-free, and 27% developed multiple primary tumors in the head and neck. Tumor stages III and IV were shown to decrease survival by half compared to stages I and II. A 42% occult nodal metastases rate was observed, and 3 of 11 patients experienced regional relapse in an untreated neck. From this review it appears that surgery, combined with postoperative radiotherapy when indicated, is an effective form of treatment for carcinoma of the soft palate and anterior tonsillar pillar.