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Elucidating the Effect of Type2 Diabetes on Periodontal Disease
No full text背景：本研究利用社區牙周指數(community periodontal index, CPI)及附連指數(attachment loss, LA)為工具，於基隆市社區整合式篩檢(Keelung community-based integrated screening, KCIS)針對35-44歲個案進行社區大規模牙周病篩檢。本研究以首次牙周篩檢及參加兩次以上篩檢資料可分別獲得牙周病盛行率及發生率。此外，本研究分別以橫斷性及世代追蹤性研究進行糖尿病與牙周病相關分析。並根據上述所獲得的盛行率、發生率及盛行率池(prevalence pool)進行牙周病平均滯留期(Mean Sojourn Time, MST)估計。
材料與方法：本研究以基隆市社區闔家歡篩檢為主，邀請2003至2005年年齡35-44歲參加民眾牙周病篩檢，同時進行CPI及LA為篩檢方法。每年篩檢執行前，先針對參加的牙醫師進行牙周病相關訓練課程，包括牙周檢查方法、牙周診斷、治療及照護等。參加個案於整合式篩檢除了參與牙周檢查外，並同時進行抽血及問卷訪視。本研究以個案參加第一次篩檢資料為橫斷性研究，除了盛行率外，以單變項及多變項邏輯氏迴歸模式(Logistic regression Model)進行牙周病與糖尿病及其他相關危險因子探討，透過調整其他危險因子後，分析糖尿病與牙周病的相關。另外，本研究利用有參加兩次以上的個案進行發生率分析，並進一步估計牙周病累積發生機率。本研究以卜瓦松迴歸模式進行牙周病發生之危險因子探討。本研究並進一步利用發生率及平均滯留期倒數建構牙周病三階段模式，包括無牙周病、牙周病及缺牙，並估算每階段轉移機率。
結果：本研究共計有8765名個案進入本研究。如果以CPI為診斷標準，取六個Sextants最為嚴重CPI的為代表性，並定義CPI>=3為牙周病個案，整體而言，牙周病盛行率約29%; 如果以附連指數(LA)為診斷，定義LA>=1為牙周個案時，其總盛行率約35%. 以CPI為指標之牙周病盛行率，男性約35.7% 及女性約25.9%，不論於男性或女性其牙周病盛行率皆呈現隨著年齡增加而增加。本研究進行有糖尿病或無糖尿病之兩組，結果有糖尿病族群相對於其無糖尿病個案其高出發生率11.3%，其中男性之糖尿病高於無糖尿病者約11.4% 及女性9%。以嚼食檳榔有無進行牙周病盛行率分析，有嚼食檳榔的個案與無嚼食檳榔個案比較，約高出14.3%。多變項邏輯氏迴歸模式分析，結果顯著相關因子包括年齡 (OR=1.06(95%CI: 1.04-1.07)), 年齡(OR=1.33(CI: 1.17-1.51)), 每天早晚有刷牙習慣相對於無習慣者 (OR=0.70(CI: 0.52-0.95)),有嚼食檳榔鄉對於無嚼食檳榔 (OR=1.29(CI: 1.08-1.54)), 有抽菸習慣者相對於無習慣者 (OR=1.23(CI: 1.07-1.40)),腰圍>=80公分 (OR=1.23(CI: 1.05-1.43)), 以及糖尿病 (OR=1.45(CI: 1.09-1.92))。如果以LA指標為牙周病診斷進行糖尿病與牙周病相關分析，結果呈現邊緣性統計相關。 本研究分別計算出各種背景下之發生率，包括年齡、性別、糖尿病有無及嚼食檳榔有無。整體牙周病發生率約(月份)每千人14.61 (12.75-16.75). 牙周病發生率隨著年齡增加而增加，其中35-39歲牙周病發生率約每千人13.97 (11.76-16.61)，40-44歲牙周病發生率約每千人15.81 (12.66-19.74)。以發生率進行1-5年累積發生機率模擬，結果逐年分別為16.08%, 29.58%, 40.90%, 50.40%, and 58.38%。本研究發現有糖尿病個案相對於無糖尿病個案或嚼食檳榔者相對於無嚼食檳榔者，其牙周病累積發生機率皆呈現較高。以卜瓦松模式進行分析，調整其他相關危險因子後，僅嚼食檳榔因素呈現統計顯著相關 (相對危險值=2.13 (95%CI: 1.31-3.46))，顯示糖尿病影響牙周病發生。牙周病發生危險相關因素分析中，調整嚼檳榔習慣後，糖尿病未達統計顯著意義(RR=1.66(95%CI:0.82-3.36))。在牙周病平均滯留期估計方面，本研究利用盛行池(發生率及盛行率)觀念進行估算，整體而言，在牙周病沒有任何積極介入下，牙周病平均滯留期約28.46個月。而在三階段模式中，估計結果顯示一年內由無牙周病轉移至牙周病的機率約15.16% ，另由牙周病轉移至缺牙機率約4.53%。
結論:本研究以盛行世代證明糖尿病與牙周病是有相關的，但若以無牙周病之追蹤世代則未呈現有意義相關，而是檳榔顯示強烈相關，依據所估計平均滯留期建議牙周治療間隔時間為一年。Background: This study was carried out to demonstrate the prevalence and incidence rate of periodontal disease(PD) by community periodontal index (CPI) and attachment loss (LA) and investigated the associations between Type 2 diabetes mellitus and periodontal disease by controlling for possible confounding factors by using community-based survey in Keelung. We also estimated the mean sojourn time (MST) of periodontal disease (PD) by prevalence pool concept.
Methods: Study population was based on participants in routine KCIS program who were 35-44 years from 2003 to 2005. The CPI and LA were used as screening tool to assess the status of PD. The courses focused on periodontal examination, diagnosis and basic treatment were carried out before the activity of Keelung Community-based Integrated Screening (KCIS) every year. The bioassay and questionnaire information were simultaneously collected by KCIS. To assess the effect of Type 2 DM on PD, a prospective cohort free of PD was designed for the investigation of the effect of Type 2 DM on PD. The univariate and multiple logistic regressions were performed to identify significant factors responsible for occurrence of PD. We used cumulative density method to calculate cumulative risk for developing PD based on incidence rate. Poisson regression model was further used to identify significant factors responsible for occurrence of incident PD. We applied prevalence pool concept based on prevalent cases at first survey and incidence cases after following up the cohort free of PD. The natural history of periodontal disease was proposed by three-state model for progression from free of PD, PD, and severest or tooth loss.
Results: The total of eligible 8765 attendants participated this KCIS multiple screening. The overall rate of PD defined by taking the severest one of CPI greater than 3 in different sextants in individual level was 29%. Similar findings were also noted for PD defined by loss attachment (LA>=1). The overall prevalence rate of loss attachment was 35%. The prevalence rates of severe CPI of male and female were 35.7% and 25.9% respectively. The prevalence rate increased with advancing age. The prevalence rate of PD in type2 diabetes was higher than that in non-diabetes by 11.3%, with 11.4% for male and 9% for female. The prevalence rate of PD in subjects with betel quids chewing was statistically higher than that in subjects without betel quids chewing by 14.3%. Multivariate logistic regression including significant indicated age (OR=1.06(CI: 1.04-1.07)), gender (OR=1.33(CI: 1.17-1.51)), twice brush-teeth per day (OR=0.70(CI: 0.52-0.95)), betel quid chewing (OR=1.29(CI: 1.08-1.54)), cigarette Smoking (OR=1.23(CI: 1.07-1.40)), Waist (OR=1.23(CI: 1.05-1.43)), and Type 2 DM (OR=1.45(CI: 1.09-1.92)). The association between Type 2 DM and PD defined by LA was borderline significant. The overall incidence of PD and specific incidence by age, gender, presence of Type 2 DM, and betel quids chewing. The incidence rate (in month) in the overall group was 14.61 (12.75-16.75) per 1000. The incidence rate (per 1000) increased with age, with 13.97 (11.76-16.61) per 1000 for subjects aged 35-39 years and 15.81 (12.66-19.74) per 1000 for subjects aged 40-44 years. The risks for PD for the overall group were 16.08%, 29.58%, 40.90%, 50.40%, and 58.38% at 1, 2, 3, 4 and 5 year of follow-up. Those diagnosed as T2DM or with the habit of betel quids chewing had higher risk for developing PD than those without Type 2 DM or the habit of betel quids chewing. After adjusting for significant factors obtained from univariate analysis, only betel quids chewing (relative risk=2.13 (CI: 1.31-3.46)) was statistically associated with the development of PD. The effect of T2DM on occurrence of PD was not statistically significant after controlling for betel quids chewing. The application of prevalence pool equation yielded 28.46 months of MST in chronic state for PD patients without appropriate intervention. The risk for having PD and for tooth missing during one-year period was 15.16% and 4.53% respectively.
Conclusions: We demonstrated a positive association between early-detected T2DM and PD based on a large population-based and community-oriented program targeted at habitant aged 35-44 years. However, the effect of Type 2 DM on newly discovered PD didn’t show significant finding. Instead, incidence rate was higher for those with the habit of betel quids chewing. This suggests the influence of Type 2 DM may be predominated by the impact of betel quids chewing. The MST estimated in the current study suggests one-year as an appropriate inter-examination interval for PD.第一章 緒論 1
一、 研究背景 1
二、 研究目的 3
第二章 牙周病與糖尿病及其他相關危險因子文獻探討 4
一、年齡(Age) 8
二、性別(Gender) 9
三、社經地位(Socioeconomic Status) 9
四、抽菸(smoking) 9
五、飲酒 9
六、 肥胖 10
七、先天性缺陷或疾病 12
八、家族聚集(Familial aggregation) 12
第三章 材料與方法 13
一、 研究族群 13
二、 研究設計 14
三、 社區篩檢資料收集 16
四、 牙周病測量及分類 16
五、 分析方法 17
第四章結果 21
一、基本發現 21
二、盛行率及發生率 23
三、盛行世代危險因子探討 24
第五章討論 56
一、研究主要發現 56
二、研究方法及設計新穎 56
三、過去研究比較 57
四、因果關係 58
五、牙周病平均停留期間 59
六、牙周病造成糖尿病 59
七、研究限制 59
第六章結論 64
參考文獻 65
圖表目錄
表1、2003-2005年社區闔家歡篩檢牙周篩檢年齡分布情形 31
表2、社區牙周病篩檢參加及未參加之及年齡分布 32
表3、社區牙周病篩檢參加及未參加牙周病篩檢之教育程度分佈情形 33
表4、社區牙周病篩檢牙周指數(CPI)檢查結果 34
表5、社區牙周病篩檢之附連喪失(Loss Attachment, LA)檢查結果 35
表6、社區牙周病篩檢性別及各年齡層牙周病（CPI>=3）盛行率 36
表7、社區牙周病篩檢性別及各年齡層牙周病（LA>=1）盛行率 37
表8、社區牙周病篩檢性別及各年齡層糖尿病與非糖尿病牙周病盛行率 38
表9、社區牙周病篩檢性別及各年齡層有無嚼檳榔習慣者其牙周病盛行率 39
表10、探討性別與糖尿病、嚼食檳榔之牙周病發生率 40
表11、社區牙周病篩檢牙周病(CPI≥3)與相關危險因子之分析 41
表12、社區牙周病篩檢附連喪失(LA≥1)與相關危險因子分析 42
表13、社區牙周病篩檢牙周病(CPI 0-4)與相關危險因子分析 43
表14、社區牙周病篩檢牙周病(LA 0-4)與相關危險因子分析 44
表15、社區牙周病篩檢對牙周病(CPI>=3)發生之相關危險因子分析(logistic單變項) 45
表16、探討糖尿病及相關危險因子對牙周病(CPI>=3)發生之分析(logistic多變項) 46
表17、探討高血糖及相關危險因子對牙周病(CPI>=3)發生之分析(logistic多變項) 47
表18、社區牙周病篩檢對牙周病(CPI>=3)發生之相關危險因子分析(單變項) 48
表19、探討性別、糖尿病及嚼食檳榔之牙周疾病期間分析 49
表20、性別、糖尿病有無、嚼食檳榔有無之牙周病或缺牙之疾病轉移機率 50
表21、以性別及牙周病有無之糖尿病發生率分析 60
表22、糖尿病發生之相關危險因子單變項分析 61
表23、參加一次及參加二次以上之年齡層比較 62
表24、參加一次及參加二次以上之教育程度比較 6
Fig. 1 in Toonaones A I, limonoids with NLRP3 inflammasome inhibitory activity from Toona ciliata M. Roem
No full textFig. 1. Structures of 1 14 isolated from Toona ciliata M. Roem.Published as part of Shi, Qiang-Qiang, Zhang, Xing-Jie, Wang, Ting-Ting, Zhang, Yu, Zeb, Muhammad Aurang, Zhang, Rui-Han, Li, Xiao-Li & Xiao, Wei-Lie, 2021, Toonaones A I, limonoids with NLRP3 inflammasome inhibitory activity from Toona ciliata M. Roem, pp. 1-11 in Phytochemistry (112661) 184 on page 2, DOI: 10.1016/j.phytochem.2021.112661, http://zenodo.org/record/829211
Fig. 10 in Toonaones A I, limonoids with NLRP3 inflammasome inhibitory activity from Toona ciliata M. Roem
No full textFig. 10. Key inter-proton distances (Å) of (6R)-6 and (6S)-6 generated by m062x/def2svp.Published as part of Shi, Qiang-Qiang, Zhang, Xing-Jie, Wang, Ting-Ting, Zhang, Yu, Zeb, Muhammad Aurang, Zhang, Rui-Han, Li, Xiao-Li & Xiao, Wei-Lie, 2021, Toonaones A I, limonoids with NLRP3 inflammasome inhibitory activity from Toona ciliata M. Roem, pp. 1-11 in Phytochemistry (112661) 184 on page 7, DOI: 10.1016/j.phytochem.2021.112661, http://zenodo.org/record/829211
Fig. 7. Correlations between experimental and calculated 13C in Toonaones A I, limonoids with NLRP3 inflammasome inhibitory activity from Toona ciliata M. Roem
No full textFig. 7. Correlations between experimental and calculated 13C NMR chemical shifts of (23S)-5 (left) and (23R)-5 (right).Published as part of Shi, Qiang-Qiang, Zhang, Xing-Jie, Wang, Ting-Ting, Zhang, Yu, Zeb, Muhammad Aurang, Zhang, Rui-Han, Li, Xiao-Li & Xiao, Wei-Lie, 2021, Toonaones A I, limonoids with NLRP3 inflammasome inhibitory activity from Toona ciliata M. Roem, pp. 1-11 in Phytochemistry (112661) 184 on page 6, DOI: 10.1016/j.phytochem.2021.112661, http://zenodo.org/record/829211
Supplemental Material, Medical_Ethics_Committee_of_Nanfang_Hospital - Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1
No full textSupplemental Material, Medical_Ethics_Committee_of_Nanfang_Hospital for Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1 by Jia-Jie Tan, Lu Wang, Ting-Ting Mo, Yuan-Feng Dai, Juan Lu, Xiong Liu, Huai-Hong Chen, Wen-Dong Tian and Xiang-Ping Li in Cell Transplantation</p
Supplementary_fig1-01 - Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1
No full textSupplementary_fig1-01 for Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1 by Jia-Jie Tan, Lu Wang, Ting-Ting Mo, Yuan-Feng Dai, Juan Lu, Xiong Liu, Huai-Hong Chen, Wen-Dong Tian and Xiang-Ping Li in Cell Transplantation</p
Supplemental Material, Animal_Ethic_Committee_To_The_Animal_Protocol - Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1
No full textSupplemental Material, Animal_Ethic_Committee_To_The_Animal_Protocol for Establishment of Immortalized Laryngeal Epithelial Cells Transfected with Bmi1 by Jia-Jie Tan, Lu Wang, Ting-Ting Mo, Yuan-Feng Dai, Juan Lu, Xiong Liu, Huai-Hong Chen, Wen-Dong Tian and Xiang-Ping Li in Cell Transplantation</p
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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