Adherence to Chronic Kidney Disease Screening Guidelines Among Patients With Type 2 Diabetes in a US Administrative Claims Database

ObjectiveTo examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database.Patients and MethodsThis cohort study used a claims database enriched with laboratory results data. Patients with T2D (defined as 1 inpatient or 2 outpatient claims for diabetes), aged 18 years or older, and with at least 1 year of follow-up enrollment were identified. Patients with type 1 diabetes, kidney disease, or other related conditions at baseline were excluded. We estimated screening rates using laboratory orders for serum creatinine and estimated glomerular filtration rate (eGFR) measurement and urine albumin to creatinine ratio (UACR). Chronic kidney disease severity was reported using the Kidney Disease: Improving Global Outcomes classification based on laboratory results.ResultsA total of 1,881,447 patients with T2D were eligible for analysis. Mean ± SD age was 63.1±13.1 years; 947,150 patients (50.3%) were male. Serum creatinine tests were ordered within 14 days of the index date among 290,722 patients of 622,915 (46.7%) patients with newly-recognized T2D. Overall, 1,595,964 patients (84.8%) had at least one serum creatinine test ordered during the 1-year follow-up period. Fewer patients received a UACR test during follow-up (814,897 [43.3%]). Less than half of all patients with T2D received a laboratory test order for both serum creatinine and urine albumin measurements during the follow-up period.ConclusionPhysicians treating patients with diabetes are selectively adhering to chronic kidney disease screening guidelines, as indicated by high rates of eGFR testing, but less frequent UACR testing. Despite recommendations to monitor both eGFR and UACR, less than half of patients were screened for albuminuria during the 1-year follow-up.     

Comparison of interfaces between a NiCr alloy and various dental ceramics using transmission electron microscopy (TEM) and 3-point bending test

Several methods (e.g. tensile strength, shear bond strength) have been used in testing metal-ceramic bonds. However, in the interface, structural and analytical investigations can be applied in determining the chemical and phase structure of substances making up the bond. The aim of the present study is to assess the interface between Wiron 99 (Bego) alloy and Vision (Wohlwend) VITA VMK68 (Vita), Carat (Dentsply/DeTrey) ceramic using transmission electron microscopy (TEM) and 3-point bending test. In the case of NiCr alloys, morphologically similar but structurally varying phases developed in all of the ceramics. In each case, a Cr2O3 layer consisting of small crystals (10-20 nm) was noticed with a series of underlying bubble-like amorphous inclusions. The exact three dimensional (3D) location of these structures and their relation to the glass-phase of the ceramic, as well as its role in the nanomechanical anchoring of the ceramic are still to be clarified. The values of debonding stress were 41.67 +/- 5.01 MPa, 52.89 +/- 8.06 MPa and 56.58 +/- 10.21 MPa for Carat, VITA VMK68 ceramic and Vision, respectively. These parameters do not present significant difference at p > or = 0.05 among the three types of ceramics. Based on our measurements it is highly likely that the micromorphology of interface is basically determined by the composition of the alloy while in the chemical composition of the newly developed phases the ceramic and the parameters of firing (temperature, magnitude of vacuum and firing time) play an important role. Values of cracking and morphological resemblance suggest that the superficial micromorphological and nanomorphological structures, acting as mechanical anchoring elements, play an important role in fixing the ceramic.     

Modern methods for studying the surface of titanium implants (literature review)

Studies of the coatings found on the surface of titanium implants employed in oral surgery are indispensable for understanding the interactions between the organism and the implant. This paper surveys the theory and practical applicability of the methods most frequently applied to study the surface structure and composition of the material. Detailed accounts are given of various structure investigation methods: scanning electron microscopy, stereo scanning electron microscopy, X-ray diffraction, atomic force microscopy and interference microscopy; and of various composition investigation methods: secondary ion mass spectroscopy, X-ray photoelectron spectroscopy, Auger electron spectroscopy; and also of the corrosion procedures for the study of electrochemical behaviour.     

Measurement of periapical pressure created by occlusal loading

The aim of this study was to develop an in vitro model in which the pressure in the periapical tissues can be measured during loading. Extracted human maxillary central incisors were embedded into resin blocks that had physical characteristics similar to bone and periodontal ligament. Each tooth was loaded with 20, 40, 50, 60, 75, 85, 100, 200, 300 and 450 N vertical forces from the incisal edge of the crown; this procedure was carried out three consecutive times. A minute resistor embedded in the periapical space was used to detect apical pressure changes during occlusal loading. The ratio of apical pressure changes (delta P) to the loading force changes (delta F) was calculated. The periapical pressure detected was in direct proportion to the loading force. The mean value of delta P/delta F was 5.994 kPa/N (SD = 2.04). Direct proportionality was found between the coronal loading and the apical hydrostatic pressure. The (delta P)/(delta F) ratio determined in this study makes it easier to estimate the apical hydrostatic pressure values during occlusal loading of single rooted teeth. In this study the apical pressure generated under occlusal loading was of the same magnitude as that estimated with the finite element method.     

Genetic association signal near NTN4 in Tourette syndrome

Tourette syndrome (TS) is a neurodevelopmental disorder with a complex genetic etiology. Through an international collaboration, we genotyped 42 single nucleotide polymorphisms (p < 10⁻³) from the recent TS genomewide association study (GWAS) in 609 independent cases and 610 ancestry‐matched controls. Only rs2060546 on chromosome 12q22 (p = 3.3 × 10⁻⁴) remained significant after Bonferroni correction. Meta‐analysis with the original GWAS yielded the strongest association to date (p = 5.8 × 10⁻⁷). Although its functional significance is unclear, rs2060546 lies closest to NTN4, an axon guidance molecule expressed in developing striatum. Risk score analysis significantly predicted case–control status (p = 0.042), suggesting that many of these variants are true TS risk alleles. Ann Neurol 2014;76:310–315     

Effect of tonsillectomy and its timing on renal outcomes in Caucasian IgA nephropathy patients

Purpose

The role of tonsillectomy in the treatment of IgA nephropathy in Caucasian patients is controversial.

Methods

A retrospective cohort study was conducted in 264 patients with biopsy-proven primary IgA nephropathy to examine the association between tonsillectomy and long-term renal survival, defined as the incidence of estimated glomerular filtration rates (eGFRs) of ≤30 ml/min/1.73 m² or end-stage renal disease (the composite of initiation of dialysis treatment or renal transplantation). The association of tonsillectomy with renal end-points was examined using the Kaplan–Meier method and Cox models.

Results

One-hundred and sixty-six patients did not undergo tonsillectomy (Group I, follow-up 130 ± 101 months) and 98 patients underwent tonsillectomy (Group II, follow-up 170 ± 124 months). The mean renal survival time was significantly longer for both end-points between those patients who underwent tonsillectomy (Group II) versus patients without tonsillectomy (Group I) (p < 0.001 and p = 0.005). The mean renal survival time was significantly longer for both end-points between those patients who had macrohaematuric episodes versus patients who had no macrohaematuric episodes (p = 0.035 and p = 0.019). Tonsillectomy, baseline eGFR and 24-h proteinuria were independent risk factors for both renal end-points.

Conclusion

Tonsillectomy may delay the progression of IgA nephropathy mainly in IgA nephropathy patients with macrohaematuria. Prospective investigation of the protective role of tonsillectomy in Caucasian patients is needed.