Skeletal Muscle Loss Is Negatively Associated With Single‐Pool Kt/V and Dialysis Duration in Hemodialysis Patients

We evaluated the skeletal muscle loss in hemodialysis (HD) patients by bioelectrical impedance analysis (BIA) and handgrip strength test. Thirty‐four HD patients and 16 healthy subjects (control group) were measured for skeletal muscle mass normalized as the skeletal muscle mass index (SMI), calculated as skeletal muscle mass (kg)/height (m)² using a tetrapolar bioelectrical impedance plethysmograph. Handgrip strength test was also performed using a hand dynamometer in both groups. In HD patients, the associations of SMI and handgrip strength with age, sex, HD conditions, and HD parameters such as body mass index (BMI), single‐pool Kt/V (spKt/V), normalized protein catabolic rate (nPCR), creatinine generation rate (CGR) and serum albumin level (Alb) were investigated. SMI of HD patients (4.58 ± 0.95 kg/m²) was significantly lower than that of the control group (5.55 ± 0.80 kg/m², P < 0.01). The handgrip strength of HD patients (19.9 ± 7.74 kg) was also significantly lower than that of the control group (33.0 ± 8.94 kg, P < 0.01). In HD patients, HD duration was associated with both SMI and handgrip strength. Among HD parameters, spKt/V was negatively associated with both SMI and handgrip strength, BMI and Alb were positively associated with SMI, while nPCR and CGR were associated with neither SMI nor handgrip strength. HD duration independently contributed to skeletal muscle loss and the value of spKt/V may be affected by skeletal muscle loss in HD patients.     

Characteristics of urinary and serum soluble Klotho protein in patients with different degrees of chronic kidney disease

Background

Klotho is a single-pass transmembrane protein, which appears to be implicated in aging. The purpose of the present study was to characterize the relationship between the soluble Klotho level and renal function in patients with various degrees of chronic kidney disease (CKD).

Methods

The levels of soluble Klotho in the serum and urine obtained from one hundred thirty-one CKD patients were determined by a sandwich enzyme-linked immunosorbent assay system.

Results

The amount of urinary excreted Klotho during the 24 hr period ranged from 1.6 to 5178 ng/day (median 427 ng/day; interquartile range [IR] 56.8-1293.1), and the serum Klotho concentration ranged from 163.9 to 2123.7 pg/ml (median 759.7 pg/ml; IR 579.5-1069.1). The estimated glomerular filtration rate (eGFR) was significantly correlated with the log-transformed values of the amount of 24 hr urinary excreted Klotho (r?=?0.407, p?<?0.01) and the serum Klotho levels (r?=?0.232, p?<?0.01). However, a stepwise multiple regression analysis identified eGFR to be a variable independently associated only with the log-transformed value of the amount of 24-hr urinary excreted Klotho but not with the log-transformed serum Klotho concentration. Despite the strong correlation between random urine protein-to-creatinine ratio and the 24 hr urinary protein excretion (r?=?0.834, p?<?0.01), a moderate linear association was observed between the log-transformed value of the amount of 24 hr urinary excreted Klotho and that of the urinary Klotho-to-creatinine ratio (Klotho/Cr) in random urine specimens (r?=?0.726, p?<?0.01).

Conclusions

The amount of urinary Klotho, rather than the serum Klotho levels, should be linked to the magnitude of the functioning nephrons in CKD patients. The use of random urine Klotho/Cr as a surrogate for the amount of 24-hr urinary excreted Klotho needs to be evaluated more carefully.

     

Successful Lung Transplantation in a Case With Diffuse Pulmonary Arteriovenous Malformations and Hereditary Hemorrhagic Telangiectasia

Diffuse pulmonary arteriovenous malformations (AVMs) are associated with a poor prognosis and the therapeutic strategy remains controversial. We describe a pediatric patient with diffuse pulmonary AVMs associated with hereditary hemorrhagic telangiectasia (HHT), who presented with two cerebral AVMs in the parietal and occipital lobes as well. Of note, successful bilateral lung transplantation not only improved the hypoxemia but also resulted in size reduction of the cerebral AVMs. Although it is essential to consider involvements other than pulmonary AVMs, especially brain AVMs, to decide the indication, lung transplantation can be a viable therapeutic option for patients with diffuse pulmonary AVMs and HHT.     

Influence of light dose on bond strength of orthodontic light-cured adhesives

Although the polymerization reaction in light-cured orthodontic adhesive continues for some time after light irradiation, it is unclear whether insufficiently irradiated adhesive develops sufficient bond strength. This in vitro study examined the maturation of bond strength after exposure of a variety of light doses. Large metal brackets were bonded to the enamel of 288 bovine mandibular incisors by irradiation at two light intensities (200 and 400 mW/cm(2)) and for three exposure times (3, 5, and 10 seconds) using three orthodontic adhesives (TB, OP, and BOB). Shear bond strengths and adhesive remnant indices (ARIs) were determined immediately (T1) and 24 hours after bonding (T2; n = 8 in each group). Comparisons were made using the Kruskal-Wallis H-test, the Bonferroni-corrected Mann-Whitney U-test, and the Yates-corrected chi-square test. Bond strengths of the adhesives that showed maturation at low light intensity (200 mW/cm(2)) increased by 1.4- to 2.0-fold in 24 hours. An increase in exposure time increased bond strength more than did an increase in light intensity for most orthodontic adhesives. With an exposure time of 3 seconds at 200 mW/cm(2), the ARI scores of TB and OP differed significantly between T1 and T2. Thus, the most acceptable procedure when applying low-dose light intensity to a bracket before the placement of a wire is to increase the exposure time and/or wait for sufficient maturation of bond strength.     

Efficient palatal expansion with a quadhelix appliance: an in vitro study using an experimental dental arch model

This study used an experimental dental arch model to examine the orthodontic forces generated by a quadhelix appliance in terms of parallel expansion, fan expansion, or a combination of the two. Strain gauges were attached to experimental brass rods that represented the teeth arranged in the shape of an average dental arch to detect forces in the buccal, lingual, mesial, and distal directions. Orthodontic forces generated by different types of activation were compared by Scheffe's multiple test. The largest orthodontic force generated during parallel expansion was observed at the first molar in the buccal direction. When fan expansion was applied, significant orthodontic force was observed at the canine in the mesial and labial directions, whereas force in the mesial and lingual directions was noted at the first molar. When a combination of 3 mm parallel and 5 mm fan expansion was used, the forces generated at the canine and first and second premolar, and first molar were nearly equivalent. Depending on the type of malocclusion, the most appropriate expansion technique may be parallel or fan expansion or a combination of the two. When expanding the entire dental arch simultaneously, a combination of 3 mm parallel and 5 mm fan expansion may be the most suitable.     

Regioisomeric differentiation of the alkyl-substituted synthetic cannabinoids JWH-122 and JWH-210 by GC-EI-MS/MS

Synthetic cannabinoids (SCs) are known to have structural or positional isomers. While regulations on synthetic drugs like synthetic cathinones and SCs have been placed worldwide for the ever-growing variety of new designer drugs, laws may not necessarily be applicable to their isomers. Toxicological differences may also exist among isomers for which most new designer drugs are still uninvestigated; thus, isomer differentiation becomes of forensic importance. The aim of this study was to differentiate the regioisomers of alkyl-substituted naphthoylindole-type SCs JWH-122 and JWH-210. Reference standards of the two drugs and their regioisomers were analyzed by gas chromatography–electron ionization-mass spectrometry (GC–EI-MS) first in full scan mode. Isomers that produced identical EI spectra were further analyzed by GC-tandem mass spectrometry (MS/MS) by selecting appropriate precursor ions. For JWH-210, comparison of the product ion spectra and the relative ion intensity ratios obtained from precursor ions at m/z 312 and 183 enabled differentiation between all seven regioisomers. Complete isomeric differentiation by MS/MS analysis was not attainable for JWH-122; however, combining chromatographic results with MS/MS analysis results enabled differentiation for all isomers. Two basic fragmentation pathways were speculated for both SCs; for JWH-210, fragmentation pathway tendencies differed among the isomers, resulting in their distinguishability. Our results demonstrated that the difference between the methyl (JWH-122) and ethyl (JWH-210) group substituents contributed to fragmentation pathway tendency differences and further distinguishability between the regioisomers. Functional group differences, especially their stereochemistries, were indicated to be critical factors in positional isomer differentiation by GC-MS/MS.     

Effect of cortical bone thickness and implant placement torque on stability of orthodontic mini-implants

PURPOSE: To examine the relationship between cortical bone thickness, inter-root distance (horizontal space), distance from alveolar crest to the bottom of maxillary sinus (vertical space) at the prepared site, and implant placement torque and the success rate of mini-implants placed for orthodontic anchorage. MATERIALS AND METHODS: After computerized tomography examination, mini-implants 1.6 mm wide and 8 mm long were placed in the posterior alveolar bone. The mini-implant was judged a success when orthodontic force could be applied for at least 6 months without pain or clinically detectable mobility. The unpaired t test was performed to examine differences between the success and failure groups. The chi-square analysis or Fisher exact probability test was used to compare the implant success according to placement torque, location, and patient gender. P values less than .05 were considered significant. RESULTS: The subjects included 4 males (11 implants) and 28 females (76 implants) who ranged in age from 14.6 to 42.8 years. The success rate of the 87 implants was 87.4%. Cortical bone thickness was significantly greater in the success group (1.42 +/- 0.59 mm vs 0.97 +/- 0.31 mm, P = .015). The success rate was significantly higher in the group with an implant placement torque of 8 to 10 Ncm (100%) as compared to implants with higher or lower placement torques. The odds ratio for failure of the mini-implant was 6.93 (P = .047) when the cortical bone thickness was less than 1.0 mm relative to 1.0 mm or more. CONCLUSION: A relationship between stability after implant placement and the width and height of the peri-implant bone was not demonstrated. The prepared site should have a cortical bone thickness of at least 1.0 mm, and the placement torque should be controlled up to 10 Ncm.