Validity of malnutrition scores for predicting mortality in chronic hemodialysis patients

Purpose

Malnutrition is a strong predictor of mortality in hemodialysis patients. Several scoring systems for evaluating nutritional status have been proposed. However, they rely on different sets of anthropometric and laboratory markers to make a diagnosis of malnutrition and assess its impact on prognosis. To validate them, nutritional scores should be compared with clinical outcomes. Thus, the purpose of this study was to assess malnutrition by three different nutrition scoring systems and determine which best predicts mortality in hemodialysis patients.

Methods

This prospective study included 106 adult chronic hemodialysis patients. Their mean age was 56.3 ± 14.9 years and mean body mass index 24.8 (21.8–28.9); 52 % were men and they had been on dialysis for 24 (5–55) months. Nutritional status was classified according to the diagnostic systems proposed by Wolfson et al. (Am J Clin Nutr 39(4):547–555, 1984), International Society of Renal Nutrition and Metabolism (ISRNM) (Fouque et al. in Kidney Int 73(4):391–398, 2008), and Beberashvili et al. (Nephrol Dial Transplant 25(8):2662–2671, 2010). During about 2 years of follow-up, mortality was assessed by Kaplan–Meier curves, log-rank, and Cox’s models adjusted for diabetes, sex, C-reactive protein, time on dialysis, age, and fractional urea clearance.

Results

Twenty-three deaths (21.5 %) occurred during the study period. According to the systems of Wolfson, Beberashvili, and the ISRNM, 54, 32, and 20 % of patients, respectively, had malnutrition. Both univariate and multivariate analyses showed that the ISRNM system was the only one that predicted poorer survival (fourfold higher death risk) in malnourished patients.

Conclusions

The scoring system proposed by the ISRNM most accurately identifies patients at higher risk of death.     

The Role of Angiotensin II on Sodium Appetite After a Low‐Sodium Diet

The present study aimed to investigate the role of angiotensin II (Ang II) on sodium appetite in rats subjected to a normal or a low‐sodium diet (1% or > 0.1% NaCl) for 4 days. During sodium restriction, a reduction in water intake, urinary volume and sodium excretion was observed. After a low‐sodium diet, we observed decreased plasma protein concentrations and haematocrit associated with a slight reduction in arterial pressure, without any significant changes in heart rate, natraemia, corticotrophin‐releasing hormone mRNA expression in the paraventricular nucleus and corticosterone levels. After providing hypertonic saline, there was an increase in saline intake followed by a small increase in water intake, resulting in an enhanced saline intake ratio and the recovery of arterial pressure. Sodium deprivation increased plasma but not brain Ang I and II concentrations. A low‐sodium diet increased kidney renin and liver angiotensinogen mRNA levels but not lung angiotensin‐converting enzyme mRNA expression. Moreover, Ang II type 1a receptor mRNA expression was increased in the subfornical organ and the dorsal raphe nucleus and decreased in the medial preoptic nuclei, without changes in the paraventricular nucleus and the nucleus of solitary tract after a low‐sodium diet. Blockade of AT₁ receptors or brain Ang II synthesis led to a reduction in sodium intake after a low‐sodium diet. Intracerebroventricular injection of Ang II led to a similar increase in sodium and water intake in the control and low‐sodium diet groups. In conclusion, the results of the present study suggest that Ang II is involved in the increased sodium appetite after a low‐sodium diet.     

Comparison of different ultrasonic vibration modes for post removal

This in vitro study compared different ultrasonic vibration modes for intraradicular cast post removal. The crowns of 24 maxillary canines were removed, the roots were embedded in acrylic resin blocks, and the canals were treated endodontically. The post holes were prepared and root canal impressions were taken with self-cured resin acrylic. After casting, the posts were cemented with zinc phosphate cement. The samples were randomly distributed into 3 groups (n=8): G1: no ultrasonic vibration (control); G2: tip of the ultrasonic device positioned perpendicularly to core surface and close to the incisal edge; and G3: tip of the ultrasonic device positioned perpendicularly to core surface at cervical region, close to the line of cementation. An Enac OE-5 ultrasound unit with an ST-09 tip was used. All samples were submitted to the tensile test using an universal testing machine at a crosshead speed of 1 mm/min. Data were subjected to one-way ANOVA and Tukey's post-hoc tests (α=0.05). Mean values of the load to dislodge the posts (MPa) were: G1 = 4.6 (± 1.4) A; G2 = 2.8 (± 0.9) B, and G3= 0.9 (± 0.3) C. Therefore, the ultrasonic vibration applied with the tip of device close to the core's cervical area showed higher ability to reduce the retention of cast post to root canal.     

Effects of photobiomodulation on the fatigue level in elderly women: an isokinetic dynamometry evaluation

Aging is responsible by a series of morphological and functional modifications that lead to a decline of muscle function, particularly in females. Muscle tissue in elderly people is more susceptible to fatigue and, consequently, to an increased inability to maintain strength and motor control. In this context, therapeutic approaches able of attenuating muscle fatigue have been investigated. Among these, the photobiomodulation demonstrate positive results to interacts with biological tissues, promoting the increase in cell energy production. Thus, the aim of this study was to investigate the effects of photobiomodulation (808 nm, 250 J/cm², 100 mW, 7 J each point) in the fatigue level and muscle performance in elderly women. Thirty subjects entered a crossover randomized double-blinded placebo-controlled trial. Photobiomodulation was delivered on the rectus femoris muscle of the dominant limb immediately before the fatigue protocol. In both sessions, peripheral muscle fatigue was analyzed by surface electromyography (EMG) and blood lactate analysis. Muscle performance was evaluated using an isokinetic dynamometer. The results showed that photobiomodulation was able of reducing muscle fatigue by a significant increase of electromyographic fatigue index (EFI) (p?=?0.047) and decreasing significantly lactate concentration 6 min after the performance of the fatigue protocol (p?=?0. 0006) compared the placebo laser session. However, the photobiomodulation was not able of increasing muscle performance measured by the isokinetic dynamometer. Thus, it can be conclude that the photobiomodulation was effective in reducing fatigue levels. However, no effects of photobiomodulation on muscle performance was observed.     

Effect of poplar-type propolis on oxidative stability and rheological properties of O/W emulsions

Propolis is known to possess antioxidant activity. However, there is no information on this activity in emulsions O/W. The protective effect of propolis on the oxidation and rheological properties of emulsions O/W containing wheat germ and almond oils was evaluated. Emulsions O/W were prepared with different concentration of propolis extract, almond oil and wheat germ oil. All emulsions physically stable without phase separation were stored at 37?°C for 9?weeks. Chemical composition of propolis was established by Gas chromatography coupled to mass spectrometry. Rheological characterization of different emulsions was performed evaluating consistency index and flow behavior index. The oxidation was monitored by measuring the lipid hydroperoxides and thiobarbituric acid-reactive substances (TBARS) methods. Flavonoids, phenolic acid esters, and aromatic acids were the main groups of compounds found in propolis. The results showed that popolis was good antioxidant in the concentration of 0.02 and 0.04% when lipid phase was constituted by almond oil. The rheological behavior is typical of a non-Newtonian fluid, being almond oil more adequate for having a higher stable O/W emulsion.     

HIV cure: global overview of bNAbs’ patents and related scientific publications

Introduction: This article provides a global overview of patent deposits for broadly neutralizing antibodies (bNAbs), which have emerged as a key strategy for HIV cure and future HIV vaccines. Scientific and technological barriers to the discovery of an effective HIV vaccine in the last 40 years have raised concerns on the potential for relevant advances in this area. Nevertheless, recent breakthrough studies have identified novel immune pathways for new innovative HIV vaccine and HIV cure strategies.

Areas covered: In our patent study, we have identified in a global scale, in the last decade, a sharp increase in the number of bNAbs’ patent deposits related to HIV prevention and treatment strategies, reaching 90 bNAbs in 2017, protected by 184 different patent deposits. Refining our patent search to the different stages of bNAbs’ development has also allowed us to identify 12 of them already at clinical stage of research (VRC01, 10E8, 3BNC117, 10-1074, 2G12, 2F5, KD-247, 4E10, PG9, PGDM1400, PGT121, and VRC07). We describe these recent breakthroughs and discuss the prospects and limitations of these novel strategies.

Expert opinion: Our results indicate the intellectual property outcomes of a scientific revolution in this field, expressing innovative modifications in antibodies to increase their potency and half-life, which have resulted in extremely potent antibodies that could provide novel preventive and therapeutic HIV strategies.     

The influence of C-factor, flexural modulus and viscous flow on gap formation in resin composite restorations

This study analyzed the influence of C-factor, flexural modulus and viscous flow on gap formation in resin composite restorations. Two resin composites, a mini-filled hybrid (P 60) and a nanofilled (Supreme), were used. The flexural modulus was obtained from bar-shaped specimens submitted to three-point bending. Viscous flow was obtained from the difference between the initial and final diameter of resin composite disks submitted to a load of 10 N for 120 seconds. Gap analysis was conducted in three types of cylindrical cavities (C-factor of 1.8, 2.6 and 3.4) that were prepared on the occlusal surfaces of human molars. The gap width at the dentin-resin composite interface was measured using a 3D scanning system (Talyscan 150). The data were analyzed by ANOVA and Student-Newman-Keuls' test, t-test and linear regression analysis (alpha = 0.05). The cavities with C-factor 3.4 presented the highest Gap formation (p < 0.0001). The lowest Gap formation was found in cavities restored with Supreme resin composite (p < 0.0001). P 60 presented significantly higher flexural modulus and lower viscous flow than Supreme (p < 0.0001). Regression analyses detected a significant influence of flexural modulus and viscous flow on gap formation (p < 0.05).     

On the Determination of Elastic Properties of Single-Walled Boron Nitride Nanotubes by Numerical Simulation

The elastic properties of chiral and non-chiral single-walled boron nitride nanotubes in a wide range of their chiral indices and diameters were studied. With this aim, a three-dimensional finite element model was used to assess their rigidities and, subsequently, elastic moduli and Poisson’s ratio. An extensive study was performed to understand the impact of the input parameters on the results obtained by numerical simulation. For comparison, the elastic properties of single-walled boron nitride nanotubes are shown together with those obtained for single-walled carbon nanotubes.