Clinical and Practical Use of Calcimimetics in Dialysis Patients With Secondary Hyperparathyroidism

CKD and CKD-related mineral and bone disorders (CKD-MBDs) are associated with high cardiovascular and mortality risks. In randomized clinical trials (RCTs), no single drug intervention has been shown to reduce the high mortality risk in dialysis patients, but several robust secondary analyses point toward important potential beneficial effects of controlling CKD-MBD–related factors and secondary hyperparathyroidism. The advent of cinacalcet, which has a unique mode of action at the calcium-sensing receptor, represented an important step forward in controlling CKD-MBD. In addition, new RCTs have conclusively shown that cinacalcet improves achievement of target levels for all of the metabolic abnormalities associated with CKD-MBD and may also attenuate the progression of vascular and valvular calcifications in dialysis patients. However, a final conclusion on the effect of cinacalcet on hard outcomes remains elusive. Tolerance of cinacalcet is limited by frequent secondary side effects such as nausea, vomiting, hypocalcemia and oversuppression of parathyroid hormone, which may cause some management difficulties, especially for those lacking experience with the drug. Against this background, this review aims to summarize the results of studies on cinacalcet, up to and including the publication of the recent ADVANCE and EVOLVE RCTs, as well as recent post hoc analyses, and to offer practical guidance on how to improve the clinical management of the most frequent adverse events associated with cinacalcet, based on both currently available information and personal experience. In addition, attention is drawn to less common secondary effects of cinacalcet treatment and advisable precautions.     

Maternal reproductive performance and fetal development of the Wistar Audiogenic Rat (WAR) strain

Wistar Audiogenic Rat (WAR) strain is an animal model for epilepsy studies, the chronic multifactorial disease that affects millions of people worldwide. The animals of this strain are genetically predisposed to sound-induced seizures, called audiogenic seizures, and have been used for many years in studies to understand the mechanisms involved in the epilepsies and their neuropsychiatric comorbidities, as well as the screening of potential anti-convulsant agents. Nevertheless, little is known about the reproductive characteristics of these animals. The main goal of this study was to characterize the female reproductive performance and the fetal growth of WARs in comparison to the Wistar rats, obtaining important information for physiology and behavioral studies, as well as for the preservation of the strain. The results indicated few differences between WAR and Wistar regarding the female reproductive performance. There was no significant difference in the number of pregnant females by mating, number of live births per female, number of cells per blastocyst, and several characteristics related to reproductive performance, such as pre- and post-implantation losses. However, significant differences were observed in birth weight and weight gain until weaning, with WAR animals presenting a body weight below Wistar at birth and reduced body weight gain during the lactation period. In addition, the WAR females showed lower body weight on the day 20 of pregnancy and a larger number of corpora lutea, when compared with those of Wistar animals. Thus, we conclude that although Wistar and WAR strains have few differences in their reproductive performance, which might impact future physiological life challenges or others experimentally induced procedures, it still is a very viable strain regarding reproduction.

Abbreviations: CONCEA: National Council for the Control of Animal Experimentation; GEPR: genetically epilepsy-prone rats; WAR: Wistar Audiogenic Rat.     

Preoperative Management of Endocrine,Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.     

Engineered Polysaccharides: α‐1,3‐Glucan Acetates Showing Upper Critical Solution Temperature in Organic Solvents

Acetates of α‐1,3‐glucan dissolved in N,N‐dimethyl acetamide/LiCl are prepared by converting the polysaccharide with acetyl chloride, acetic acid anhydride/pyridine, or with acetic acid/N,N′‐carbonyl diimidazole. Values of the degree of substitution for the acetyl groups (DS_Ac) of up to 2.6 are realized. NMR spectroscopic measurements reveal a preferred conversion of the primary hydroxyl group at position 6 followed by positions 2 and 4. Depending on the DS_Ac, the samples may be soluble in solvents of different polarity at room temperature or at elevated temperatures showing upper critical solution temperature at DS of about 2.5. This process is found to be reversible.     

The Private Practice of Prosthodontists: Current and Future Conditions of Practice in the United States (Part 2)

PURPOSE: Data are used to examine current and future conditions important to the private practice of prosthodontics. A concern is raised as to whether the future supply of prosthodontists is in sync with the dynamics of the US population and patient population. MATERIALS AND METHODS: Four trends are examined using data from various sources. The trends include: (1) growth in the number of private practicing prosthodontists, (2) projections of the future number of private practicing prosthodontists, (3) first year enrollment in dental schools, and (4) enrollments and graduates in residency programs. RESULTS: The number of private practicing prosthodontists has increased modestly over the past 21 years, growing 1.33% per year. The number of private practitioners is projected to reach 4,125 in 2025. A key variable in this projection is the growing number of elderly adults. While dental school enrollments have been increasing, concern is raised about the amount of exposure by students to an undergraduate curriculum in prosthodontics. There has been a general decline in enrollment in the nation's prosthodontics residency programs at the rate of -2.9% per year. An average of 181 program graduates are needed to achieve the 4125 projected number of private practitioners. CONCLUSION: Increasing demand for services from prosthodontists is supported by an increasing US population size and a growing population of elderly. Efforts to grow the number of private practicing prosthodontists will have to consider several concerns including residency program enrollments, undergraduate exposure to prosthodontics, and the overall economic returns expected from engaging in the private practice of prosthodontics. Choosing a career as a private practicing prosthodontist is a timely consideration and complimented by expected increases in demand for care and favorable financial returns to practice.     

Control of polymerization shrinkage and stress in nanogel-modified monomer and composite materials

Objectives

This study demonstrates the effects of nano-scale prepolymer particles as additives to model dental monomer and composite formulations.

Methods

Discrete nanogel particles were prepared by solution photopolymerization of isobornyl methacrylate and urethane dimethacrylate in the presence of a chain transfer agent, which also provided a means to attach reactive groups to the prepolymer. Nanogel was added to triethylene glycol dimethacrylate (TEGDMA) in increments between 5 and 40 wt% with resin viscosity, reaction kinetics, shrinkage, mechanical properties, stress and optical properties evaluated. Maximum loading of barium glass filler was determined as a function of nanogel content and composites with varied nanogel content but uniform filler loading were compared in terms of consistency, conversion, shrinkage and mechanical properties.

Results

High conversion, high molecular weight internally crosslinked and cyclized nanogel prepolymer was efficiently prepared and redispersed into TEGDMA with an exponential rise in viscosity accompanying nanogel content. Nanogel addition at any level produced no deleterious effects on reaction kinetics, conversion or mechanical properties, as long as reactive nanogels were used. A reduction in polymerization shrinkage and stress was achieved in proportion to nanogel content. Even at high nanogel concentrations, the maximum loading of glass filler was only marginally reduced relative to the control and high strength composite materials with low shrinkage were obtained.

Significance

The use of reactive nanogels offers a versatile platform from which resin and composite handling properties can be adjusted while the polymerization shrinkage and stress development that challenge the adhesive bonding of dental restoratives are controllably reduced.     

Effect of different finishing and polishing techniques on the surface roughness of microfilled, hybrid and packable composite resins

This study examined the average surface roughness (Ra, microm) of 2 microfilled (Durafill and Perfection), 1 hybrid (Filtek Z250) and 2 packable composite resins (Surefil and Fill Magic), before (baseline) and after eight different finishing and polishing treatments. The surface roughness was assessed using a profilometer. Ten specimens of each composite resin were randomly subjected to one of the following finishing/polishing techniques: A -- carbide burs; B -- fine/extrafine diamond burs; C -- Sof-Lex aluminum oxide discs; D -- Super-Snap aluminum oxide discs; E -- rubber polishing points + fine/extrafine polishing pastes; F -- diamond burs + rubber polishing points + fine/extrafine polishing pastes; G -- diamond burs + Sof-Lex system; H -- diamond burs + Super-Snap system. Data were analyzed using two-way ANOVA and Tukey's HSD test. Significant differences (p<0.05) were detected among both the resins and the finishing/polishing techniques. For all resins, the use of diamond burs resulted in the greatest surface roughness (Ra: 0.69 to 1.44 microm). The lowest Ra means were obtained for the specimens treated with Sof-Lex discs (Ra: 0.11 to 0.25 microm). The Ra values of Durafill were lower than those of Perfection and Filtek Z250, and these in turn had lower Ra than the packable composite resins. Overall, the smoothest surfaces were obtained with the use the complete sequence of Sof-Lex discs. In areas that could not be reached by the aluminum oxide discs, the carbide burs and the association between rubber points and polishing pastes produced satisfactory surface smoothness for the packable and hybrid composite resins, respectively.     

Correlations among autonomic, sensory, and motor neural function tests in untreated non-insulin-dependent diabetic individuals

A well-defined group of untreated non-insulin-dependent (NIDD) subjects were evaluated to determine whether involvement of neural function measurements is generalized and symmetrical and to compare the autonomic, sensory, and motor neural measurements. After age adjustment, the sensory and motor neural function measurements were significantly slower in the diabetic group than in normal subjects (P less than 0.01). Similarly, the autonomic nervous system function measurements were also abnormal in the NIDD group (P less than 0.01). Further analysis revealed that each of the specific measurements--median motor nerve conduction velocity (NCV,P less than 0.005), peroneal motor NCV (P less than 0.005), median sensory NCV (P less than 0.005), dark-adapted pupil size after muscarinic blockade (P less than 0.02), pupillary latency time (P less than 0.02), and RR-variation after beta adrenergic blockade (P less than 0.001)--was significantly less by analysis of covariance after age adjustment in the NIDD group than in normal subjects. Thus, there was evidence of motor and sensory neural impairment in the upper and lower extremities as well as evidence of impairment of the reflex arcs involving the parasympathetic nerves to the heart and eye and the sympathetic nerves to the iris. Further analysis revealed that right and left NCV were correlated (P less than 0.01), as were the median motor and median sensory NCV (P less than 0.01), the median motor and peroneal motor NCV (P less than 0.001), and the peroneal motor and median sensory NCV (P less than 0.001). Thus, there was evidence of symmetrical upper and lower limb, as well as motor and sensory proportional involvement of large nerve fiber NCV in this group of NIDD subjects.(ABSTRACT TRUNCATED AT 250 WORDS)