Novel Risk Factors for Progression of Diabetic and Nondiabetic CKD: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

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The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine

OBJECTIVES: The authors conducted a randomized, double-blind, two-way crossover clinical trial to compare the pharmacokinetics and cardiovascular effects of 11.9 milliliters of 4 percent articaine hydrochloride (HCl) plus 1:100,000 epinephrine (A100) with those of 11.9 mL of 4 percent articaine HCl plus 1:200,000 epinephrine (A200). METHODS: During two testing sessions, the authors administered injections of A100 and A200 over a seven-minute period (in one-cartridge doses unless otherwise noted): maxillary right first molar infiltration, maxillary left first molar infiltration, maxillary right first premolar infiltration, maxillary left first premolar infiltration, right inferior alveolar injection, left inferior alveolar injection, right long buccal infiltration (one-half cartridge) and left long buccal infiltration (one-half cartridge). They analyzed venous blood samples for articaine levels. They used noninvasive acoustic tonometry to measure a variety of cardiovascular parameters over a two-hour period. RESULTS: Plasma concentration curves of articaine over time were similar for both solutions, with peak concentrations and times to maximum concentration being 2,037 nanograms per milliliter and 22 minutes for A100 and 2,145 ng/mL and 22 minutes for A200. At the 10-minute point, the mean systolic blood pressure and heart rate were significantly elevated (P < .05) with A100 versus A200. CONCLUSIONS: Maximum dose recommendations for the A100 solution also can be applied to the A200 solution. A200 produces less cardiovascular stimulation than does A100. CLINICAL IMPLICATIONS: A200 is as safe as A100, and may be preferable to A100 in patients with cardiovascular disease and in those taking drugs that reportedly enhance the systemic effects of epinephrine.     

The hyoid bone in malay infants with cleft lip and palate.

OBJECTIVE: To compare morphological and positional variations of the hyoid bone in unoperated infants with cleft lip and palate (CL/P) with those in noncleft infants. DESIGN: Retrospective, cross sectional. PATIENTS AND METHODS: Three-dimensional computed tomography scans were obtained from 29 unoperated CL/P infants of Malay origin aged between 0 and 12 months and from 12 noncleft infants in the same age range. Observations were made and measurements were obtained with a software package developed at the Australian Craniofacial Unit. The sizes of the hyoid bones and the position of the hyoid body and epiglottis in relation to the cervical spine were measured. Anatomical anomalies of the hyoid and prevalence of aspiration pneumonia were also documented. RESULTS: The hyoid bones and epiglottis were found to be located more inferiorly in CL/P infants compared with the noncleft infants. Also, 17% (5/29) of the CL/P infants had nonossified hyoid bodies. CONCLUSION: The results suggest that there are differences in the location and genesis of the hyoid bone in infants with CL/P that warrant further investigation.     

Comparison of exposed dentinal surfaces resulting from abrasion and erosion

The aim of this study was to compare the shape of exposed dentinal surfaces caused by abrasion and erosion with a view to developing a diagnostic clinical test. The study material consisted of 80 natural teeth and 129 dental models obtained from Australian Aborigines known to display considerable dental abrasion due to their diet, and dental models of 37 Caucasians diagnosed with dental erosion through detailed history and dietary analysis. Polyvinyl siloxane impressions were obtained of all occlusal surfaces with dentinal scooping in both the ‘abrasion’ and ‘erosion’ groups. All impressions were sectioned buccolingually through the deepest point of the scooped dentine, and then the profiles were photocopied at X 2 magnification. The breadth and depth of dentinal profiles were measured to an accuracy of 0.1 mm, enabling ratios of depth:breadth to be determined, and the position of the deepest part of each scooped surface was recorded. The mean depth:breadth ratio of scooped dentine was significantly greater in the Aboriginal natural teeth (0. 19±60.06, mean±SE) than in the Aboriginal dental models (0.15±0.04). Both Aboriginal natural teeth and models with abrasion showed significantly smaller ratios (p<0.05) than the Caucasian models showing erosion (0.33±.07). Furthermore, in the abrasion samples, the deepest region of the scooped dentine tended to be lingually placed more often in maxillary teeth but buccally placed more often in mandibular teeth (p<0.05). These results indicate that scooped dentine on abraded occlusal surfaces of teeth displays significant differences in shape compared with that caused mainly by erosion.     

Twins and twinning, dentists and dentistry

Comparisons of physical features within identical (monozygous) and non-identical (dizygous) twin pairs have provided valuable insights into the relative contributions of genetic and environmental influences to observed variability. The special nature of the twinning process itself also provides an opportunity to learn more about early human development, including how body symmetry is determined. The mechanisms of twinning, mortality and morbidity in twins, determination of body symmetry including the phenomenon of mirror-imaging, postnatal growth and development of twins, and zygosity determination are discussed. Twin studies with direct relevance to clinical dentistry are reviewed and illustrated by examples from an ongoing investigation of dentofacial morphology in South Australian twins.     

Comparison of exposed dentinal surfaces resulting from abrasion and erosion

The aim of this study was to compare the shape of exposed dentinal surfaces caused by abrasion and erosion with a view to developing a diagnostic clinical test. The study material consisted of 80 natural teeth and 129 dental models obtained from Australian Aborigines known to display considerable dental abrasion due to their diet, and dental models of 37 Caucasians diagnosed with dental erosion through detailed history and dietary analysis. Polyvinyl siloxane impressions were obtained of all occlusal surfaces with dentinal scooping in both the 'abrasion' and 'erosion' groups. All impressions were sectioned buccolingually through the deepest point of the scooped dentine, and then the profiles were photocopied at X 2 magnification. The breadth and depth of dentinal profiles were measured to an accuracy of 0.1 mm, enabling ratios of depth:breadth to be determined, and the position of the deepest part of each scooped surface was recorded. The mean depth:breadth ratio of scooped dentine was significantly greater in the Aboriginal natural teeth (0. 19±60.06, mean±SE) than in the Aboriginal dental models (0.15±0.04). Both Aboriginal natural teeth and models with abrasion showed significantly smaller ratios (p<0.05) than the Caucasian models showing erosion (0.33±.07). Furthermore, in the abrasion samples, the deepest region of the scooped dentine tended to be lingually placed more often in maxillary teeth but buccally placed more often in mandibular teeth (p<0.05). These results indicate that scooped dentine on abraded occlusal surfaces of teeth displays significant differences in shape compared with that caused mainly by erosion.     

The size of permanent teeth in Klinefelter (47,XXY) syndrome in man

The permanent teeth tended to be larger than normal in a group of 77 males with the syndrome, indicating that the presence of an extra X-chromosome has a growth-promoting effect which operates from early in development.     

Electromagnetic interference caused by common surgical energy-based devices on an implanted cardiac defibrillator

Background

Surgical energy-based devices emit energy, which can interfere with other electronic devices (eg, implanted cardiac pacemakers and/or defibrillators). The purpose of this study was to quantify the amount of unintentional energy (electromagnetic interference [EMI]) transferred to an implanted cardiac defibrillator by common surgical energy-based devices.

Methods

A transvenous cardiac defibrillator was implanted in an anesthetized pig. The primary outcome measure was the average maximum EMI occurring on the implanted cardiac device during activations of multiple different surgical energy-based devices.

Results

The EMI transferred to the implanted cardiac device is as follows: traditional bipolar 30 W .01 ± .004 mV, advanced bipolar .004 ± .003 mV, ultrasonic shears .01 ± .004 mV, monopolar Bovie 30 W coagulation .50 ± .20 mV, monopolar Bovie 30 W blend .92 ± .63 mV, monopolar instrument without dispersive electrode .21 ± .07 mV, plasma energy 3.48 ± .78 mV, and argon beam coagulator 2.58 ± .34 mV.

Conclusion

Surgeons can minimize EMI on implanted cardiac defibrillators by preferentially utilizing bipolar and ultrasonic devices.     

Spatially robust estimates of biological nitrogen (N) fixation imply substantial human alteration of the tropical N cycle

Biological nitrogen fixation (BNF) is the largest natural source of exogenous nitrogen (N) to unmanaged ecosystems and also the primary baseline against which anthropogenic changes to the N cycle are measured. Rates of BNF in tropical rainforest are thought to be among the highest on Earth, but they are notoriously difficult to quantify and are based on little empirical data. We adapted a sampling strategy from community ecology to generate spatial estimates of symbiotic and free-living BNF in secondary and primary forest sites that span a typical range of tropical forest legume abundance. Although total BNF was higher in secondary than primary forest, overall rates were roughly five times lower than previous estimates for the tropical forest biome. We found strong correlations between symbiotic BNF and legume abundance, but we also show that spatially free-living BNF often exceeds symbiotic inputs. Our results suggest that BNF in tropical forest has been overestimated, and our data are consistent with a recent top-down estimate of global BNF that implied but did not measure low tropical BNF rates. Finally, comparing tropical BNF within the historical area of tropical rainforest with current anthropogenic N inputs indicates that humans have already at least doubled reactive N inputs to the tropical forest biome, a far greater change than previously thought. Because N inputs are increasing faster in the tropics than anywhere on Earth, both the proportion and the effects of human N enrichment are likely to grow in the future.Over the last few decades, humans have dramatically altered the global nitrogen (N) cycle (1–3). Three main processes—Haber–Bosch fixation of atmospheric N₂, widespread cultivation of leguminous N-fixing crops, and incidental N fixation during fossil fuel combustion—collectively add more reactive N to the biosphere each year than all natural processes combined (2). Although human perturbation of the N cycle has brought substantial benefits to society (most notably, an increase in crop production) (4), it has also had a number of negative effects on both ecosystems (5, 6) and people (7).Although humanity’s large imprint on the global N cycle is clear, quantifying the extent of anthropogenic changes depends, in large part, on establishing baseline estimates of nonanthropogenic N inputs (1, 8, 9). Before recent human activities, biological N fixation (BNF) was the largest source of new N to the biosphere (9). Terrestrial BNF has been particularly challenging to quantify, because it displays high spatial and temporal heterogeneity at local scales, it arises from both symbiotic associations between bacteria and plants as well as free-living microorganisms (e.g., in leaf litter and soil) (10), and high atmospheric concentrations of N₂ make direct flux measurements unfeasible. Consequently, spatial estimates of BNF have always been highly uncertain (11), and global rate estimates have fallen precipitously in the last 15 y (from 100–290 to ∼44 Tg N y⁻¹) (9). This decline in BNF implies an increase in the relative magnitude of anthropogenic N inputs from 100–150% to 190–470% of BNF (9).Historically, the largest anthropogenic changes to the N cycle have occurred in the northern temperate zone: first throughout the United States and western Europe and more recently, in China (12, 13). Large-scale estimates of BNF in natural ecosystems in these regions are consistently low (11), leading some to conclude that anthropogenic N inputs in the northern temperate zone exceed naturally occurring BNF and preindustrial atmospheric N deposition by an order of magnitude or more (1, 14). By contrast, the highest rates of naturally occurring BNF have been thought to occur in the evergreen lowland tropical rainforest biome (11), implying that, on a regional basis, human alteration of the tropical N cycle has been comparatively modest. However, in recent years, the tropics have seen some of the most dramatic increases in anthropogenic N inputs of any region on Earth—a trend that is likely to continue (2, 6, 13). Anthropogenic N inputs are increasing in tropical regions, primarily because of increasing fossil fuel combustion (13) and expanding high-N-input agriculture for both food and biofuels (6). These anthropogenic N inputs are having a measurable effect on tropical ecosystems (15). However, understanding and forecasting the effects of anthropogenic N depend, in part, on accurate estimates of BNF in lowland tropical rainforest.Unfortunately, the paradigm that the tropics have high rates of BNF is based on a paucity of evidence and several tenuous assumptions. For example, an early global synthesis of terrestrial BNF (11)—which included contributions from both symbiotic and free-living sources—included only one measured estimate of symbiotic BNF from tropical forest (16 kg N ha⁻¹ y⁻¹) (16). That single estimate, scaled over thousands of square kilometers, represented the only direct evidence of high tropical BNF rates available at that time (Fig. 1). Subsequent modeled estimates (17) that indirectly estimated BNF have reinforced the notion that tropical BNF rates are high and dominated by the symbiotic form of fixation (Fig. 1). Such high estimates of symbiotic BNF are consistent with the large number of leguminous trees in tropical forest (18–20). However, many legume species do not form N-fixing nodules (21), and of those species that do, nodulation in individuals varies with soil nutrient status, N demand, and tree age (22). Several recent analyses (10, 22–24) indicate lower tropical forest BNF and suggest that symbiotic BNF may not be as important to total BNF as previously thought (Fig. 1), although few studies have simultaneously measured symbiotic and free-living BNF.Open in a separate windowFig. 1.Previous estimates of BNF in tropical rainforest and BNF measured in this study. Percentages indicate the proportion of total BNF from symbiotic BNF. Cleveland et al. 1999 A (11) is a literature database-derived estimate of tropical forest BNF; Cleveland et al. 1999 B (11) is a modeled estimate of BNF based on the correlation between net primary productivity (NPP) and BNF derived with remotely sensed NPP and evergreen broadleaved forest (EBF) land cover classification. Central estimates and variance for Cleveland et al., 1999 A (11) and Reed et al. 2011 (10) represent the low, central, and high data-based estimates of BNF assuming 5%, 15%, and 15% legume cover, respectively. Central estimates and variance for Wang and Houlton 2009 (17) represent the modeled mean and SD of BNF predicted for the EBF biome. Central estimates and variance for Cleveland et al. 2010 (23) represent the low, central, and high estimates of symbiotic BNF plus free-living BNF or modeled BNF plus free-living BNF. Central estimates and variance for BNF in the four forest ages measured here (primary, 5–15 y, 15–30 y, and 30–50 y) represent means ± 1 SD (n = 3). Our estimate of BNF in a dynamic primary forest (gap dynamics) lacks SD, because it consisted of only two measurements: low and high estimates of forest turnover times equal to 150 and 75 y, respectively.There is also a sound theoretical basis for questioning high estimates of BNF in tropical forest. Namely, high concentrations of soil N in the legume-rich tropics create something of a paradox. Although BNF could create N-rich conditions, the substantial energetic cost of BNF means—and some data show—that BNF should be suppressed under high N availability in primary forests (25). Because of high rates of net primary productivity and high N demand in secondary forests (26, 27), regenerating canopy gaps or abandoned agricultural land may have higher rates of BNF than late-successional forest ecosystems (26).Resolving the uncertainty in the tropical (and global) N cycle requires that we overcome the enduring challenge of quantifying BNF in any ecosystem. How do we estimate large-scale rates of a process that displays extreme spatial heterogeneity at local scales? Whether using acetylene reduction assays, ¹⁵N tracer incubations, or the ¹⁵N natural abundance method, most past approaches to empirically estimate symbiotic BNF have relied on spatial extrapolations of BNF rates measured at the level of individual trees. Typically, such extrapolations are based on legume abundance (e.g., percent cover) and make species- or genera-level assumptions about nodulation status of putative N fixers. Here, we applied a method commonly used by community ecologists to measure rare species abundances—stratified adaptive cluster sampling (SACS) (28)—to measure symbiotic BNF. This approach could be used in any ecosystem, and in contrast to other methods, SACS generates unbiased estimates of mean symbiotic BNF (independent of legume abundance) and can more robustly capture the irregular distribution of nodules on the landscape. We simultaneously measured symbiotic and free-living BNF multiple times over the course of 1 y to generate spatially explicit rates of BNF inputs in primary and secondary (5–50 y old) lowland tropical forest in Costa Rica and then used the understanding gained from those estimates to revisit estimates of BNF and anthropogenic N inputs in the tropical forest biome.     

Nurse-based evaluation of point-of-care assays for glycated haemoglobin

BACKGROUND: Various devices are now available to measure glycated haemoglobin (HbA1c) outside of the laboratory. The aim of this study was to assess the performance of these point-of-care instruments in the hands of non-laboratory trained personnel. METHODS: Two nursing staff tested samples from patients attending a diabetes research clinic using the following point-of-care devices for HbA1c-Metrica A1C Now, Bayer DCA 2000, Cholestech GDX and Axis-Shield Nycocard HbA1c. In addition they performed regular analysis of quality control samples. The effects on analytical performance of multiple operators as well as laboratory-trained staff, were also assessed. All measurements were compared to a boronate-affinity HPLC method in the central laboratory. RESULTS: The mean HbA1c difference of the point-of-care devices compared to the laboratory reference method ranged from -0.31% to +0.39%. Only the DCA device had a between batch imprecision of less than 5%. The analytical performance obtained by laboratory staff was similar to nursing staff for 3 devices and better for the Nycocard device. CONCLUSIONS: On the basis of the results obtained by nursing staff, only the DCA of the devices tested, can be recommended for measurement of HbA1c outside of the laboratory.