Effect of captopril on renal function in patients with essential hypertension

The glomerular filtration rate (creatinine clearance), glomerular permeability (qualitative and quantitative proteinuria), tubular reabsorption (k-λ chains of immunoglobulins and lysozyme) and indexes of tubular cell lysis (alpha-glucosidase and gamma-glutamyltranspeptidase) were measured in the urine of 10 patients with moderate, uncomplicated essential hypertension during placebo therapy and after captopril given at increasing doses of 25, 50, 100 and 200 mg twice daily, the first three doses being given for 3 days and the last one for 4 weeks in all patients and for an additional 6 months in 5 patients. During placebo therapy, proteinuria was absent in eight patients and detectable (glomerular and selective) in two; selective proteinuria appeared in two and a decrease in selectivity was observed in two patients with previous proteinuria after 4 weeks of captopril therapy. No proteinuria was detectable in the five patients followed up for 6 months, not even in the one in whom a decrease in glomerular selectivity had occurred after 4 weeks. The glomerular filtration rate was unchanged as were lysozyme and gamma-glutamyltranspeptidase values, while light chains were always undetectable. Alpha-glucosidase showed some increase; however, increments were transient and always much lower than those observed with known tubular toxic drugs. These data show that under our experimental conditions captopril caused no evident changes in glomerular and tubular function.     

Is multiple SNP testing in BRCA2 and BRCA1 female carriers ready for use in clinical practice? Results from a large Genetic Centre in the UK

BRCA1 and BRCA2 are major breast cancer susceptibility genes. Nineteen single nucleotide polymorphisms (SNPs) at 18 loci have been associated with breast cancer. We aimed to determine whether these predict breast cancer incidence in women with BRCA1/BRCA2 mutations. BRCA1/2 mutation carriers identified through the Manchester genetics centre between 1996 and 2011 were included. Using published odds ratios (OR) and risk allele frequencies, we calculated an overall breast cancer risk SNP score (OBRS) for each woman. The relationship between OBRS and age at breast cancer onset was investigated using the Cox proportional hazards model, and predictive ability assessed using Harrell's C concordance statistic. In BRCA1 mutation carriers we found no association between OBRS and age at breast cancer onset: OR for the lowest risk quintile compared to the highest was 1.20 (95% CI 0.82–1.75, Harrell's C = 0.54), but in BRCA2 mutation carriers the association was significant (OR for the lowest risk quintile relative to the highest was 0.47 (95% CI 0.33–0.69, Harrell's C = 0.59). The 18 validated breast cancer SNPs differentiate breast cancer risks between women with BRCA2 mutations, but not BRCA1. It may now be appropriate to use these SNPs to help women with BRCA2 mutations make maximally informed decisions about management options.     

The female pelvic floor through midlife and aging

Female pelvic floor is a complex functional unit involved in multiple functions that extend beyond the sole support of pelvic organs. Pelvic floor dysfunction globally affects micturition, defecation and sexual activity. Evolutionary modifications such ad adaptation to upright standing, walking and the need to deliver fetuses with larger head diameters made the fascial and muscle support of the pelvic floor vulnerable, therefore predisposing women to pelvic organ prolapse and incontinence. Different than in males, the female pelvic floor undergoes a number of adaptive changes related to life and endocrine events. Most of the clinical manifestations of these changes become apparent after menopause and throughout aging in women. This review article summarizes the key aspects of the pathophysiology and the clinics of the modifications of the pelvic floor in women through midlife and beyond. A particular focus is given to the relationship between urinary and bowel dysfunction.     

Implant-supported mandibular splinting affects temporomandibular joint biomechanics

Objectives: Mandibular functional movements lead to complex deformations of bony structures. The aim of this study was to test whether mandibular splinting influences condylar kinematics and temporomandibular joint (TMJ) loading patterns. Materials and methods: Six subjects were analyzed by means of dynamic stereometry during jaw opening–closing with mandibles unconstrained as well as splinted transversally by a cast metal bar fixed bilaterally to two implant pairs in the (pre)molar region. Statistical analysis was performed by means of ANOVAs for repeated measurements (significance level α=0.05). Results: Transversal splinting reduced mandibular deformation during jaw opening–closing as measured between two implants in the (pre)molar region on each side of the mandible significantly by 54%. Furthermore, splinting significantly reduced the distance between lateral condylar poles (average displacement vector magnitude of each pole: 0.84±0.36 mm; average mediolateral displacement component: 45±28% of the magnitude) and led to a medial displacement of their trajectories as well as a mediolateral displacement of stress‐field paths. Conclusions: During jaw opening–closing, splinting of the mandible leads to a significant reduction of mandibular deformation and intercondylar distance and to altered stress‐field paths, resulting in changed loading patterns of the TMJ structures. To cite this article:
Zaugg B, Hämmerle CHF, Palla S, Gallo LM. Implant‐supported mandibular splinting affects temporomandibular joint biomechanics.
Clin. Oral Impl. Res. 23 , 2012; 897–901
doi: 10.1111/j.1600‐0501.2011.02241.x