Is there a difference in treatment effect of different intra-articular drugs for temporomandibular joint osteoarthritis? A systematic review of randomized controlled trials.

A systematic review based on the PRISMA guidelines was conducted to investigate and compare treatment with hyaluronic acid (HA), corticosteroids, and blood products in patients with temporomandibular joint osteoarthritis (TMJOA). The MEDLINE/PubMed, Embase, and Cochrane Library databases were searched for articles published until September 25, 2019. Articles met the inclusion criteria if they reported patients with TMJOA, a comparison group, and a follow-up period of at least 6 months. The mean and standard deviation for TMJ pain and maximum mouth opening (MMO) were reported. Nine studies involving 443 patients were included. Injectables and Ringer's lactate solution or normal saline were reported to significantly improve TMJ pain and MMO. Regarding TMJ pain, two studies showed a significant superiority of plasma rich in growth factors (PRGF)/platelet-rich plasma (PRP) injections with or without arthrocentesis over HA, but HA showed a significant improvement compared to corticosteroids. For MMO, no injectable was found to be superior to Ringer's lactate or a normal saline control, but arthrocentesis + PRP resulted in MMO improvement compared to arthrocentesis + HA. Overall, all injectables in conjunction with arthrocentesis were efficient in alleviating pain and improving MMO in TMJOA patients; however, a meta-analysis was not possible due to heterogeneity across studies.

Is there an association between the use of antidepressants and complications involving dental implants? A systematic review and meta-analysis.

The aim of this systematic review was to evaluate published evidence on the association between the use of antidepressants and complications involving dental implants. Two reviewers independently performed electronic searches of the MEDLINE/PubMed, Cochrane Library, and Scopus databases for relevant articles published up to May 30, 2019. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Newcastle-Ottawa Scale was used for the appraisal of the methodological quality of the studies included. A meta-analysis was performed to determine the risk of dental implant failure in individuals taking antidepressants. Five comparative observational studies were selected for this review; these included a total of 2056 participants with 5302 implants. The results suggest a risk ratio of 3.73 (95% confidence interval 1.85-7.52, P=0.0002) for implant failure in antidepressant users submitted to oral rehabilitation when compared to non-users. However, these studies did not present methodological rigour or standardize the drugs used. Thus, there is insufficient evidence for an association between antidepressant use and dental implant complications.

Is there an association between overweight/obesity and dental implant complications? A systematic review and meta-analysis.

The aim of this systematic review was to test the following hypotheses: (1) that there is no difference in implant survival rate between individuals with overweight or obesity and those who are within the ideal weight range; (2) that there are no differences between these groups regarding indicators of peri-implant health. Two independent reviewers performed a literature search of the PubMed/MEDLINE, Scopus, and Cochrane Library databases for studies published up to April 1, 2018. A meta-analysis was performed to determine the risk difference for implant failure and mean difference for marginal bone loss, probing depth, and bleeding on probing. Six studies were selected for review, involving a total of 746 patients with 986 implants: 609 in overweight or obese individuals and 377 in individuals within the ideal weight range. The findings of this systematic review indicate that the first hypothesis should be accepted, since no statistically significant difference in implant survival rate was found between individuals with overweight/obesity and those within the ideal weight range (P=0.64). The second hypothesis was rejected, as the review indicated a difference in marginal bone loss (P<0.00001), probing depth (P<0.00001), and bleeding around dental implants (P<0.00001).

L-Arginine and allopurinol protect against cyclosporine nephrotoxicity.

The role of nitric oxide (NO) and oxygen free radicals in cyclosporine (CsA) nephrotoxicity was investigated using L-arginine, an NO substrate, and allopurinol, a xanthine oxidase inhibitor (involved in the formation of oxygen radicals) in an experimental model with Wistar rats. CsA, administered at 15 mg/kg/body weight (BW) subcutaneously for 10 days, caused a decrease in glomerular filtration rate, with inulin clearance of 0.33+/-0.04 vs. 1.11+/-0.06 ml/min/100 g BW (P<0.01 vs. control). L-Arginine, 1.5% in drinking water 5 days before and during CsA administration, partially protected the animals against this fall in glomerular filtration rate, with inulin clearance of 0.68+/-0.03 ml/min/100 g BW (P<0.01 vs. CsA). Allopurinol, at 10 mg/kg/BW by gavage, also had a protective action, with inulin clearance of 0.54+/-0.04 ml/min/100 g (P<0.01 vs. CsA). CsA caused an elevation in NO production, as assessed by urinary excretion of its metabolites, nitrite and nitrate (NO2 and NO3; 0.836+/-0.358 vs. 0.107+/-0.019 nmol/microg creatinine). NO production was as much as threefold higher in the L-arginine group (1.853+/-0.206 nmol/g creatinine). This CsA effect is probably related to its vasoconstrictive stimulus. Supplementation with L-arginine, which provides more substrate for NO formation, may enhance vasodilatation and consequently reduce the impairment of renal function. The protection provided by allopurinol may be related to the reduced formation of oxygen radicals, preventing the deleterious effects of lipid peroxidation.

Effect of amphotericin B on water and urea transport in the inner medullary collecting duct.

The clinical usefulness of amphotericin B (AMP-B) is limited by its nephrotoxicity, as characterized by decreased RPF, decreased GFR, impaired urinary acidification, and potassium excretion defects. Defects of renal concentrating ability have been noted, but the mechanisms responsible for them have not been investigated. The chief objective of this research was to analyze directly the effect of AMP-B on arginine-vasopressin (AVP)- or dibutyrl cAMP (DcAMP)-stimulated water and urea transport of the inner medullary collecting duct (IMCD) obtained from rats by the in vitro microperfusion technique. AMP-B (10(-5) M) added to the bath fluid in the absence of AVP did not impair the hydraulic conductivity (Lp) and the urea permeability (Pu) of rat IMCD. AMP-B (10(-5) M) added to the bath fluid decreased the AVP-stimulated Lp (x 10(-6) cm/s.atm) of rat IMCD from 19.41 +/- 2.19 to 10.00 +/- 1.39 (P < 0.001), and the reversibility of its action was observed during a third period when Lp increased to 19.80 +/- 2.19 (P < 0.001) after the initial conditions were restored. In addition, AMP-B reduced DcAMP-stimulated Lp from 20.95 +/- 1.75 to 10.52 +/- 0.71 (P < 0.01) in a reversible manner when the drug was withdrawn from the bath. AMP-B also decreased AVP-stimulated Pu (x 10(-5) cm/s) when added to the bath fluid from 36.60 +/- 2.05 to 29.88 +/- 1.36 (P < 0.001), and this effect was reversible after AMP-B was withdrawn from the bath (37.40 +/- 1.36; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute nephrotoxicity caused by amphotericin B in the dog]. / Nefrotoxicidade aguda da anfotericina-B no cão.

Amphotericin-B is the drug of choice for the treatment of serious systemic fungal infections. The major limitation for the use of this drug is its potential nephrotoxicity. The chronic and acute administration causes both a reduction of renal blood flow and glomerular filtration rate, determining a fall of renal concentrating ability. Our study was designed to determine the acute effects of Amphotericin-B on dogs renal function, during hydropenia and water diuresis. In addition a hemodynamic study, with the measurement of intrarenal blood flow by the microsphere method was performed. The hydropenic dogs received the drug directly into the left renal artery. There was a significant decrease in creatinine clearance, urinary osmolality, and urinary solute excretion, in the left kidney only. Amphotericin-B was infused into the aorta above the renal arteries in the group in which the water diuresis was induced. This acute infusion produced intense fall in creatinine clearance and in the free water formation, as well as in absolute excretion of sodium. The hemodynamic study showed that the reduction of creatinine clearance may be due to the decrease in renal blood flow, and the alterations in the urinary excretion of water and sodium could not be correlated with the distribution of cortical blood flow to the deep nephrons. These findings suggest that the effects of Amphotericin-B may be attributed, at least in part, to its ischemic action.

[Renal regulation of sodium excretion in experimental heart failure: study of hemodynamics and renal tubular function]. / Regulação renal da excreção de sódio na insuficiência cardíaca experimental: estudo da hemodinâmica e da função tubular renal.

This study was designed to evaluate the role of the kidney on sodium retention in congestive heart failure by clearance and hemodynamic studies. Twenty seven dogs were studied during hydropenia and aqueous diuresis 96 hours after the construction of a bilateral femoral A-V fistula, in 3 periods: 1) with open fistulae; 2) with closed fistulae and 3) with reopened fistulae. The animals retained sodium and water and developed edema during the first period when the fistulae were opened. Closure of the AV fistulae produced an enhanced diuresis and natriuresis associated with an increase in phosphaturia and distal sodium delivery, suggesting a diminished proximal sodium reabsorption. However, when the fistulae were reopened, sodium retention was observed in the presence of an increase in free-water clearance corrected by distal sodium delivery, indicating an increase in sodium reabsorption by distal segments. These findings were not associated with alterations in cortical distribution of renal blood flow. In conclusion, the sodium and water retention in congestive heart failure produced by A-V fistula is due to an increase in sodium reabsorption by the distal nephron segments, and it is not associated to a redistribution of the cortical renal blood flow.

Effect of potassium depletion on ischemic renal failure.

The present study was carried out to examine the effect of potassium depletion in rat kidneys subjected to a temporary ischemic event produced by clamping of left renal artery. The postischemic kidneys of rats on a normal diet with adequate potassium intake showed an increase in H2O, Na and K excretion, with no change in inulin clearance whereas significant differences were found in potassium-deprived rats. Potassium depletion was brought about by dietary K deprivation for 10 days. K-depleted rats (serum K = 2.5 +/- 0.1 mEq/l) had a decrease in inulin clearance of the postischemic kidney from 1.01 +/- 0.10 to 0.43 +/- 0.05 ml/min (p less than 0.01), and a greater increase in fractional excretion of H2O, Na and K when compared to normal rats. The postischemic kidney from both normal and hypokalemic rats showed a decrease in Na-K-ATPase of the inner stripe of the outer medulla. These data indicate that short-term ischemia produces polyuria, increases natriuresis and kaliuresis, associated, at least in part, with a decrease in Na-K-ATPase in the inner stripe of the outer medulla (probably the thick ascending limb of Henle) and that K depletion potentiates ischemic renal failure.

Efeito do furosemide e aminofilina na insuficiencia renal aguda pos-isquemica experimental. / Effects of furosemide and aminophylline in experimental post-ischemic acute renal failure

O efeito do furosemide e da aminofilina sobre a recuperacao da insuficiencia renal aguda foi estudado em ratos submetidos a isquemia renal por clampeamento da aorta,abaixo e acima da arteria renal esquerda, permanecendo o rim direito como controle. A administracao de altas doses de furosemide (100 mg/kg peso), antes de se proceder a isquemia renal,nao impediu a queda de filtracao glomerular e o efeito oligurico. O furosemide injetado em outros oito animais, apos a inducao da isquemia renal, nao alterou a taxa de filtracao glomerular (0,24 +/- 0,04 ml/min para 0,23 +/- 0,04 ml/min), produzindo apenas aumento da diurese e natriurese em seis dos animais estudados. A administracao de aminofilina, inibidor da adenosina, substancia vasoconstritora renal, cuja producao aumenta durante a isquemia renal, tambem nao aumentou a taxa de filtracao glomerular do rim pos-isquemico (0,09 +/- 0,04 ml/min para 0,10 +/- 0,02 ml/ min) e nem alterou a excrecao de agua e soluto. Estes dados permitem concluir que nem o furosemide e nem a aminofilina produzem uma recuperacao mais rapida da filtracao glomerular na insuficiencia renal aguda experimental e que apenas o furosemide pode transformar uma insuficiencia renal aguda oligurica em poliurica