Association between prediabetes and risk of chronic kidney disease: a systematic review and meta-analysis.

AIMS: To assess the effect of prediabetes (impaired fasting glucose and/or impaired glucose tolerance) on the incidence of chronic kidney disease. METHODS: PubMed and EMBASE were searched (for studies published up to March 2015). Effects estimated from cohort studies reporting the relationship of prediabetes to incident chronic kidney disease [kidney damage (microalbuminuria, albuminuria or proteinuria) and/or decreased glomerular filtration rate] were pooled using a random-effects model meta-analysis. RESULTS: Nine cohort studies with a total of 185 452, mainly Asian and white, participants were followed for a total of 835 146 person-years. In eight cohort studies defining impaired fasting glucose as fasting glucose 6.1-6.9 mmol/l, the summary relative risk of chronic kidney disease after adjustment for established risk factors was 1.11 (95% CI 1.02-1.21). When a study defining impaired fasting glucose as fasting glucose 5.6-6.9 mmol/dl was added, the overall relative risk of chronic kidney disease was 1.12 (95% CI 1.02-1.21). Exclusion of the only study with information on impaired glucose tolerance did not change the relative risk (1.12; 95% CI 1.02-1.21). There was no evidence of publication bias (P value for Egger test = 0.12). CONCLUSION: Prediabetes is modestly associated with an increase in chronic kidney disease risk, but this remains to be robustly confirmed. Chronic kidney disease screening among people with prediabetes, and aggressive management of prediabetes in those with chronic kidney disease may be warranted.

In dementia with Lewy bodies, Braak stage determines phenotype, not Lewy body distribution.

We used an autopsy series to determine whether the newest dementia with Lewy bodies (DLB) consensus pathologic classification correlates with premortem diagnosis of DLB. Neocortical sections from a total of 95 cases with Lewy bodies were stained with alpha-synuclein antibodies. We assigned cases according to the DLB consensus' categories and found a significant association with the premortem clinical diagnosis of DLB. Clinical diagnosis of DLB, however, depended on the presence of low Alzheimer disease pathology (by Braak staging) rather than on Lewy body distribution.

Multidisciplinary approach to patients with poorly controlled type 2 diabetes mellitus: a prospective, randomized study.

Practicing physicians as well as diabetes specialists are confronted with the often-frustrating experience of dealing with patients with poorly controlled diabetes. It is not always obvious why these patients fail to improve. The aims of this study were two-fold: (a). to determine if the interdisciplinary approach offered by the Western Negev Mobile Clinic Diabetes Program (WNMDCP) is of benefit in patients with poorly controlled type 2 diabetes and (b). to more fully characterize patients refractory to treatment. Two primary-care clinics of the Western Negev were randomly selected as control and intervention. All patients from both clinics with hemoglobin (HbA(1C)) >or=10% (tested during June-July 2000) were studied for 6 months. Patients from the control clinic continued the usual treatment. Patients from the intervention clinic received the interdisciplinary approach offered by WNMCDP. The rate of improvement of diabetes control, measured as a decrease in HbA(1C) values of at least 0.5%, and compliance to treatment were determined. Overall, 48 of 258 patients in the intervention clinic and 34 of 179 patients in the control clinic met the inclusion criteria. At the 6-month follow-up, we observed significant improvements in plasma glucose (-1.5 mmol/l; p=0.003) and HbA(1C) (-1.8%; p=0.00001) in the intervention group but not in the control group. The compliance and response rates were 85% and 71% for the intervention group and 32% and 35% for the control group, respectively. Patients from the intervention clinic showed significant improvement in the endpoints compared to patients from the control clinic. More than 70% of patients with poorly controlled diabetes mellitus responded to the interdisciplinary treatment approach offered by WNMDCP. The group of non-responders comprised patients with poor compliance (15%) and those with serious concomitant diseases or limitations of mobility.

Western Negev Mobile Diabetes Care Program: a model for interdisciplinary diabetes care in a semi-rural setting.

We describe a mobile diabetes clinic aimed to provide comprehensive, interdisciplinary care to patients with diabetes resident on a semi-rural area. A mobile, tertiary care diabetes clinic, composed of a diabetologist, a diabetes nurse-educator and a dietitian, was created. The clinic regularly visited the primary-care facilities of 3 towns of the Western Negev, a semi-rural area of southern Israel. A standardized, computer-based clinical protocol was applied. Analysis of data was performed on records of all patients who had had at least 2 visits to the clinic. Of 492 patients who met the inclusion criteria, 93.6% were diagnosed with type 2 diabetes, 58% were female, the mean age was 60 years and the mean time after diagnosis of diabetes was 10 years. Most patients had not visited a diabetes center before implementation of the mobile clinic. Parameters of clinical practice such as nutritional advice by a dietitian, interaction with a diabetes nurse-educator, performance of periodic ophthalmologic examination, and measurement of microalbumin excretion improved dramatically after opening of the mobile clinic. Modifiable clinical variables such as body mass index (p<0.0001), systolic (p<0.001) and diastolic (p<0.05) blood pressures, fasting plasma glucose (p<0.001), hemoglobin A1c (p<0.01), LDL-cholesterol (p<0.01) and HDL-cholesterol (p<0.0001) improved significantly after implementation of the program. The implementation of a mobile diabetes care program in an area of low-density population is feasible. Significant improvement in parameters of clinical practice and of modifiable variables of diabetes control was achieved. The mobile diabetes clinic brought the interdisciplinary diabetes-care team to the patients' area of residence. Limited manpower answered the requirement of a geographically spread population.

ATM phosphorylation of Nijmegen breakage syndrome protein is required in a DNA damage response.

Nijmegen breakage syndrome (NBS) is characterized by extreme radiation sensitivity, chromosomal instability and cancer. The phenotypes are similar to those of ataxia telangiectasia mutated (ATM) disease, where there is a deficiency in a protein kinase that is activated by DNA damage, indicating that the Nbs and Atm proteins may participate in common pathways. Here we report that Nbs is specifically phosphorylated in response to gamma-radiation, ultraviolet light and exposure to hydroxyurea. Phosphorylation of Nbs mediated by gamma-radiation, but not that induced by hydroxyurea or ultraviolet light, was markedly reduced in ATM cells. In vivo, Nbs was phosphorylated on many serine residues, of which S343, S397 and S615 were phosphorylated by Atm in vitro. At least two of these sites were underphosphorylated in ATM cells. Inactivation of these serines by mutation partially abrogated Atm-dependent phosphorylation. Reconstituting NBS cells with a mutant form of Nbs that cannot be phosphorylated at selected, ATM-dependent serine residues led to a specific reduction in clonogenic survival after gamma-radiation. Thus, phosphorylation of Nbs by Atm is critical for certain responses of human cells to DNA damage.

In vitro evaluation of antibiotic elution from polymethylmethacrylate (PMMA) and mechanical assessment of antibiotic-PMMA composites.

OBJECTIVE: To determine whether different methods of sterilization of antibiotic vials or the heat of polymerization altered the antimicrobial activity or mechanical properties of antibiotic/polymethylmethacrylate (PMMA) composites when compared to antibiotic-free PMMA. STUDY DESIGN: In vitro study. METHODS: Steam-sterilized, gas-sterilized, and non-sterilized 1 gram vials of cefazolin and injectable gentamicin sulfate (high and low doses) were mixed with PMMA to prepare composites for antibiotic elution evaluation, compression, and elongation testing. Blocks of PMMA that contained antibiotic were assayed for antibacterial activity using an agar gel diffusion method or were placed in phosphate buffered saline (PBS) to assess elution of antibiotic. Phosphate buffered saline samples from steam-sterilized cefazolin and high-dose gentamicin groups were assayed on days 1, 2, 5, and 9 for cefazolin or gentamicin concentration by high-pressure liquid chromatography or fluorescent polarization immunoassay, respectively. RESULTS: PMMA blocks containing antibiotic inhibited bacterial growth of Staphylococcus aureus 25923 for an average of 9 days. Cefazolin and gentamicin concentration in PBS decreased dramatically after the first 24 hours, but remained above minimum inhibitory concentration (MIC) throughout the experiment for all groups except low-dose gentamicin. Compressive strength of plugs made from plain cement and plugs made from PMMA mixed with untreated and steam-sterilized cefazolin was similar, but was significantly different from the other groups. There appeared to be an inverse relationship between compressive strength and elongation. CONCLUSION: PMMA/antibiotic composites inhibited bacterial growth for 7 to 10 days. Compressive strength was affected by different additions of antibiotic. CLINICAL RELEVANCE: Bacteria introduced during a surgical procedure may be inhibited by elution of antibiotic from PMMA at the time of contamination.

Tardy displacement of traumatic radial head dislocation in childhood.

The diagnosis of traumatic dislocation of the radial head, either isolated or as part of a Monteggia fracture-dislocation, was delayed in 10 of the 110 children treated with these injuries during the study period. In eight children, the dislocation was overlooked on the initial radiographs. In two children, the radial head was reduced on the initial elbow radiographs, but it was dislocated 10 days later in one child and 21 days later in the other. The most likely explanation is that the radial head dislocated at the time of impact, spontaneously reduced by the time the first radiographs were obtained, and redislocated while the arm was in a cast. We conclude that radiographic assessments of the radiocapitellar joint, by using the radiocapitellar line, are required in children with elbow and forearm injuries at presentation and when the cast is removed.

Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997).

OBJECTIVE: To describe and compare a simple continuous suture pattern with a simple interrupted pattern for enterotomy closure or end-to-end intestinal anastomosis. DESIGN: Retrospective study. ANIMALS: 58 dogs and 25 cats that underwent enterotomy or intestinal resection and anastomosis. PROCEDURE: Signalment, surgical procedure, suture pattern, suture material, confirmation of dehiscence, and follow-up were reviewed. Groups were compared by procedure (anastomosis or enterotomy) and by suture pattern. RESULTS: 57 animals underwent continuous closure; 26 had interrupted closure. Only polydioxanone or polypropylene suture materials were used. Overall, 81 (98%) animals had no signs of intestinal dehiscence and survived > 2 weeks. Two animals had confirmed dehiscence after foreign body removal, 1 of 57 (2%) after continuous closure, and 1 of 26 (4%) after interrupted closure. CLINICAL IMPLICATIONS: The simple continuous closure pattern is an acceptable alternative to simple interrupted closure for small intestinal anastomosis or enterotomy closure.

Muscle tension patterns during auditory attention.

Although there is much evidence demonstrating muscle tension changes during mental work, there are few data concerning muscle tension patterns during effortful attention to simple sensory stimuli. In the present study, sensory attention was evoked by a pitch discrimination task at three levels of difficulty, with a digit retention task administered for comparison. Twenty-four females each performed both tasks at all levels of difficulty, while the EKG, and the corrugator supercilii, frontalis, lip, jaw, chin, and forearm area EMG were recorded. As expected, heart rate decreased significantly with increasing difficulty of the pitch task. A pattern of facial EMG responses accompanied the pitch task, which included significant increases in corrugator and frontalis, and decreases in the jaw as a function of difficulty, and time within trials. The tension pattern observed during sensory intake is discussed in terms of its relation to emotional expressions and motor theories of attention.

Investigation of a hydroxyapatite and calcium sulfate composite supplemented with an osteoinductive factor.

In the search for a suitable bone graft substitute, a study was conducted using a material that combined a proven osteoconductive composite, hydroxyapatite-calcium sulfate (HA/CS), with an osteoinductive factor, bovine osteogenic factor (OF). The initial study demonstrated the osteoinductive potential of OF in the rabbit muscle model. Once satisfied that the OF was active, it was added to the HA/CS composite and placed in 8-mm trephine defects in the rabbit cranium. This HA/CS/OF was directly compared to HA/CS augmented with a control protein, rabbit serum albumin (RSA). Animals were sacrificed at 4 and 8 weeks. Results demonstrated increased bone formation with the addition of the OF to the composite with bridging of the defects, in most cases, by 4 weeks. No bridging was seen, at this time period, in the other defects left unfilled or filled with HA/CS/RSA. Osteogenic factor, with the appropriate delivery system, can induce bone formation in the rabbit muscle. It may also increase the rate of bone formation at early time periods in a bony defect site when the delivery system is the osteoconductive composite HA/CS.

Role of heterotrophic nutrition in growth of the alga Scenedesmus obliquus in high-rate oxidation ponds.

The green alga Scenedesmus obliquus readily adapted to heterotrophic growth in the dark, utilizing glucose as the sole carbon source. Heterotrophic cells differed significantly from photoautotrophic cells with respect to several physiological properties such as the rate of photoassimilation of CO2, rate of incorporation of glucose, and chlorophyll a concentration. Oxidation pond cells shared features common to both photoautotrophic and heterotrophic cells. Approximately 15 percent of oxidation pond algal carbon was derived from glucose assimilated directly without first being oxidized by bacteria. Bacteria seem to play a minor role in biological oxygen demand reduction in high-rate oxidation ponds, and their role is probably confined to degradation of biopolymers, thus producing substrates for algal consumption.