Sphingomyelinase-Like Phosphodiesterase 3b Expression Levels Determine Podocyte Injury Phenotypes in Glomerular Disease

Diabetic kidney disease (DKD) is the most common cause of ESRD in the United States. Podocyte injury is an important feature of DKD that is likely to be caused by circulating factors other than glucose. Soluble urokinase plasminogen activator receptor (suPAR) is a circulating factor found to be elevated in the serum of patients with FSGS and causes podocyte αVβ₃ integrin-dependent migration in vitro. Furthermore, αVβ₃ integrin activation occurs in association with decreased podocyte-specific expression of acid sphingomyelinase-like phosphodiesterase 3b (SMPDL3b) in kidney biopsy specimens from patients with FSGS. However, whether suPAR-dependent αVβ₃ integrin activation occurs in diseases other than FSGS and whether there is a direct link between circulating suPAR levels and SMPDL3b expression in podocytes remain to be established. Our data indicate that serum suPAR levels are also elevated in patients with DKD. However, unlike in FSGS, SMPDL3b expression was increased in glomeruli from patients with DKD and DKD sera-treated human podocytes, where it prevented αVβ₃ integrin activation by its interaction with suPAR and led to increased RhoA activity, rendering podocytes more susceptible to apoptosis. In vivo, inhibition of acid sphingomyelinase reduced proteinuria in experimental DKD but not FSGS, indicating that SMPDL3b expression levels determined the podocyte injury phenotype. These observations suggest that SMPDL3b may be an important modulator of podocyte function by shifting suPAR-mediated podocyte injury from a migratory phenotype to an apoptotic phenotype and that it represents a novel therapeutic glomerular disease target.     

Effect of sodium deficiency on growth of surgical infants: a retrospective observational study

Background/aim

Sodium is thought to be critical to growth. Infants who have an ileostomy may suffer from growth faltering, as sodium losses from stomas may be excessive. Urinary sodium measurements may indicate which patients could benefit from sodium supplementation; however, there is no consensus on what level of urinary sodium should be the cutoff for intervention. Our aim was to determine whether there is a relationship between urinary sodium and growth in infants undergoing ileostomy, colostomy and cystostomy.

Methods

Following audit approval, a retrospective observational study of patient notes and chemical pathology data was carried out. All infants <1 year of age that had an ileostomy, colostomy, or cystostomy procedure between February 1997 and January 2014 were included. Patients’ weights, urinary and serum sodium and potassium levels and clinical variables were recorded until discharge. Weights were converted to Z-scores for analysis.

Results

Forty patients were identified whose notes were available for review and who had at least three urinary sodium measurements. During their hospital stay, 11 (28 %) maintained weight within normal limits (Z-scores ?2 to +2, 15 (38 %) were moderately malnourished (?3 to ?2) and 14 (35 %) severely malnourished (30 mmol litre. Electrolyte data were not normally distributed so that correlations between electrolytes and growth were tested using the non-parametric Spearman rank correlation coefficient. Urinary sodium levels positively correlated with growth (r = 0.3071, p < 0.0001), as did serum sodium levels (r = 0.2620, p = 0.0059) whereas there was no relationship between urine or serum potassium and growth.

Conclusions

Poor growth is frequent in this group of patients and appears to be linked with sodium levels. Further work is necessary to draw up guidelines for appropriate sodium supplementation.     

Effects of Copaiba Oil Topical Administration on Oral Wound Healing

The effects of topical copaiba oil extract and topical corticosteroid were assessed on oral wound healing in an in vivo model using 96 male Wistar rats. Traumatic ulcers were caused in the dorsum of the tongue using a 3‐mm punch tool. The animals were divided into: Control; Corticosteroid; Placebo and Copaiba oil Group. The animals received two daily applications of the products. The control group received only daily handling. Six rats in each group were euthanized at days 3, 5, 10 and 14. The animals were monitored daily to determine wound status. The weigh was assessed at day 0 and euthanasia day. The percentage of repair was calculated, and histopathological aspects were analyzed. The Kruskal–Wallis test was used to compare the results between groups and times of evaluation. Closing time was assessed through the log‐rank test. The corticosteroid group lost more weight at days 10 and 14 than the control group (p < 0.05). Moreover, the healing time of corticosteroid group was longer than the control group (p = 0.007). No differences were observed between the copaiba oil group and the control group. We concluded that topical copaiba oil, in spite of being safe, did not accelerate the process of oral wound healing. Copyright © 2017 John Wiley & Sons, Ltd.     

Characteristics of periodontal microflora in acute myocardial infarction

BACKGROUND: Periodontitis has been linked to increased risk of cardiovascular diseases. Systemic reactions associated with cardiovascular events may depend on characteristics of the subgingival microflora in periodontitis. Our objectives were to compare the numbers of cultivable bacteria, composition of subgingival microflora and clonal distribution of Actinobacillus actinomycetemcomitans (A. actinomycetemcomitans) in two groups of patients with generalized chronic periodontitis (GCP), one with an acute myocardial infarction (AMI-GCP) and the other one without AMI (non-AMI-GCP). METHODS: In all, 150 dentate individuals were screened for suitability to this study. Subgingival bacterial samples were collected from 11 AMI-GCP and 11 non-AMI-GCP patients who had been selected using strict inclusion criteria in an attempt to exclude confounding factors and to increase comparability of periodontal conditions by matching for periodontal probing depths and attachment levels. Culture methods were used to determine the total viable counts and occurrence and proportions of six periodontal bacterial species and yeasts. Polymerase chain reaction (PCR) technique was used to detect A. actinomycetemcomitans and Porphyromonas gingivalis (P. gingivalis). Intraspecies characterization of A. actinomycetemcomitans included serotyping and genotyping. RESULTS: The mean proportions of P. gingivalis (P = 0.05) and Tannerella forsythensis (T. forsythensis) (P = 0.01) were significantly lower, but the numbers of Micromonas micros (M. micros) and A. actinomycetemcomitans were up to nine times higher and the mean total number of cultivable bacteria per sample higher (P <0.01) in AMI-GCP than in non-AMI-GCP. CONCLUSION: The findings that no target subgingival species were overrepresented but the total bacterial number was higher in AMI-GCP than non-AMI-GCP patients may provide support to the hypothesis that elevated numbers of bacteria in close vicinity to sterile parenteral area present a risk for systemic health.     

Efficacy of a computerized local anesthesia device in pediatric dentistry

PURPOSE: The purpose of this study was to evaluate the efficacy of a computerized anesthesia delivery system in reducing pain during injections when compared with a traditional delivery system (i.e., syringe). METHODS: Subjects consisted of 57 patients between the ages of 5 and 13 needing operative dentistry using local anesthesia. Patients were randomly assigned to either the computerized or traditional anesthesia delivery system. Inferior alveolar block injections, palatal, and buccal infiltrations were the only injections administered throughout this study. Pain behavior was videotaped and coded throughout the study. Pain perceptions were rated using a 10 point visual analogue rating scale. Subjects were also asked to rate their overall satisfaction and approval of the dentist and the treatment received. RESULTS: Results of multivariate analysis of variance indicated that there were no significant differences between the computerized and the traditional method of administering local anesthesia when comparing pain ratings and pain behavior. Average pain ratings for the computerized method were 4.5 while the average ratings for the traditional method were 3.6. In addition, all subjects reported overall satisfaction with their dental treatment and that they would be willing to return in the future. CONCLUSIONS: A computerized anesthesia injection method was found to be comparable to the traditional method of anesthesia injection.     

Policy and research in oral health care.

The purpose of the paper is to highlight the interrelationship between social and health policy, and health services research. The principles and concepts in social and health policy in the Scandinavian welfare states are described with reference to oral health care. The concept of policy analysis is defined and distinctions are made between "analysis of policy", and "analysis for policy". The policy perspective is discussed with the focus on the planning--budgeting--implementation--evaluation cycle and related to the WHO Strategy for Health for All. Finally, the implications for oral health services research in Scandinavia are emphasized.     

Assessment of denture satisfaction

The aim of this investigation was to evaluate the reliability and validity of a complaints questionnaire, designed to measure different aspects of denture satisfaction. Two groups of patients with full maxillary and mandibular dentures participated in the study. The patients in Group 1 (n = 113) were on a waiting list for new dentures, patients in Group 2 (n = 102) had recently had new dentures fitted. Five denture complaint scales were constructed from the questionnaire. The internal consistency (coefficient alpha) of the scales varied from 0.65 to 0.92. Furthermore, the scales showed a discriminatory ability between the patient groups (P less than or equal to 0.001) and significant Pearson correlation coefficients with satisfaction-related questions (r = 0.25-0.79). The scores on the scales can be considered a quantitative measure of denture satisfaction.